Abstract
IntroductionA congenitally absent Inferior Vena Cava (IVC) is a rare anomaly that is recognised to be associated with idiopathic Deep Venous Thrombosis (DVT), particularly in the young. It may not be apparent until later in life. Retrospectively, as discussed in this case, there can be clues indicating the presence of such an anomaly from a young age. However, it is not clear whether early recognition of this condition would affect the prognosis and treatment.Case presentationA 54 year old gentleman was admitted with 3 weeks of abdominal pain and localised swelling over the right flank. Examination revealed palpable 'snake-like' tortuous, tender lumps on the abdominal wall. Past history revealed chronic non-healing venous leg ulcers, and varicose veins necessitating varicose vein ligation at a very young age. The ulcers eventually needed skin grafting.During this, current admission he was investigated and diagnosed with Deep Vein Thrombosis (DVT). CT scan, performed to search for intra-abdominal cancer, revealed absence of the Inferior Vena Cava with extensive thrombosed collaterals of the superficial abdominal and azygous veins and a congenitally atrophic left kidney.ConclusionThis is a case of one of the oldest patient described in the literature to be diagnosed with absence of the IVC. It is thought that IVC anomalies are under-diagnosed, and may be commoner than once believed. However there were vital clues in his previous medical history suspicious for an underlying venous anomaly. Idiopathic DVT in a relatively young person with a past history of chronic leg ulceration or varicose veins should be investigated for congenital anomalies of the IVC. This is best achieved by CT scan of the abdomen.
Highlights
A congenitally absent Inferior Vena Cava (IVC) is a rare anomaly that is recognised to be associated with idiopathic Deep Venous Thrombosis (DVT), in the young
CT scan, performed to search for intra-abdominal cancer, revealed absence of the Inferior Vena Cava with extensive thrombosed collaterals of the superficial abdominal and azygous veins and a congenitally atrophic left kidney. This is a case of one of the oldest patient described in the literature to be diagnosed with absence of the IVC
It is thought that IVC anomalies are under-diagnosed, and may be commoner than once believed
Summary
This gentleman had an extensive past medical history of idiopathic varicose ulceration with evidence of chronic venous hypertension from a very young age. He was managed with difficulty but achieved eventual healing of his ulcers as a young adult. The very limited data from the literature suggests that in cases of an absent IVC in young people (some data below 30 years, other data 20–40 years) the patient should have a CT of the abdomen In this case, with a relevant and extensive past history, review of the limited literature would support further radiological investigations to exclude an intra-abdominal deep venous anomaly. DVT- Deep vein thrombosis; IVC- Inferior Vena Cava; USUltrasound; CT- Computed Tomography
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