Epidural Venous Enlargements Presenting With Intractable Lower Back Pain and Sciatica in a Patient With Absence of the Infrarenal Inferior Vena Cava and Bilateral Deep Venous Thrombosis

Abstract

Case report. To present a rare anomaly of the inferior vena cava associated with radicular pain and to illustrate its imaging characteristics. Irritation of the trigeminal nerve by vascular anomalies, resulting in neuralgia is a well-recognized entity. Recently, compression of peripheral nerve roots due to enlarged epidural venous plexus has been described as a possible cause of back and radicular pain, too. A 26-year-old man presented with acute exacerbation of lower back pain associated with radiculopathy down his left thigh. On radiologic workup, a prolapse of a lumbar intervertebral disc was ruled out, but agenesis of the infrarenal segment of the inferior vena cava was found, which has caused bilateral deep venous thrombosis. Venous flow was redirected mainly via enlarged lumbar epidural, ascending lumbar, and paravertebral veins. No associated congenital heart or abdominal organ defects were found and screening for thrombophilia was negative. The patient was successfully treated with anticoagulation under which symptoms gradually resolved. The authors believe that epidural venous enlargements should be considered as a cause of radicular and/or back pain in patients with anomalies of the inferior vena cava, because pathologic processes compressing nervous structures can cause pain.