Large inferior vena cava tumor with cardiac extension revealed by venous thrombembolism in a patient with complete situs inversus: what are the odds?

Diana-Andreea Roscaneanu,Ovidiu Mitu,Antoniu Octavian Petris,Radu-Stefan Miftode,Mihai Stefan Cristian Haba,Daniela Crisu

doi:10.47803/rjc.2021.31.1.85

Abstract

Abstract Venous thromboembolism (VTE) can be the first symptom of an occult malignancy in apparently healthy individual. Inferior vena cava (IVC) tumors are rare conditions but with negative prognosis. We present the case of a 57 year-old male patient, with complete situs inversus, diagnosed with hepatic cirrhotic disease and frequent decompensations, that was hospitalized for deep venous thrombosis (DVT) and ascites. Further imagistic investigations revealed a 22 cm tumor inside the IVC with consequent Budd-Chiari syndrome that was actually causing the liver and kidney disease, extending from the infrarenal level to the right atrium. After compensation, the patient was referred to a multidisciplinary surgical team. However, the management of such patients is very difficult, and the prognosis is altered. Possible IVC leiomyosarcoma are very rare and such vascular extension has been rarely reported.

Highlights

Venous thromboembolism (VTE) can be the first symptom of an occult malignancy in apparently healthy individual
A rare cancer related to the Budd-Chiari syndrome is the leiomyosarcoma of the inferior vena cava (IVC), less than 400 cases being reported in the literature[2]
We report the case of a 57 year-old male patient, hypertensive, diabetic, known with complete situs inversus, diagnosed with ethanolic hepatic cirrhosis under specific treatment

Summary

INTRODUCTION

Venous thromboembolism (VTE) can be the first symptom of an occult malignancy in apparently healthy individual. A rare cancer related to the Budd-Chiari syndrome is the leiomyosarcoma of the inferior vena cava (IVC), less than 400 cases being reported in the literature[2] An intravascular tumor, such as leiomyosarcoma, if present in the IVC suprahepatic segment, may obstruct the blood flow and cause retrograde stasis in the hepatic veins with likely thrombosis and further Budd-Chiari syndrome manifestations. These conditions need a proper diagnosis and management as the evolution could be dramatic. The patient would remain under close observation till the surgery moment

DISCUSSION

CONCLUSIONS