Abstract
The etiology of venous thromboembolism in young patients is frequently associated with hereditary coagulation abnormalities, immunologic diseases, and neoplasia. The advent of radiological advances, namely Computed Tomography (CT) scans and venography has identified vena cava malformations as a new etiologic factor worthy of consideration. In this case report, we describe the unusual occurrence of venous thromboembolism in association with a duplicated inferior vena cava. Duplications of the inferior vena cava (IVC) are seen with an incidence of 0.2% to 3.0% in the general population. Embryogenesis of the IVC is a complex process involving the intricate formation and regression of numerous anastomoses, potentially leading to various anomalies. We present a 23-year-old Caucasian woman with IVC duplication who developed a deep venous thrombosis and multiple pulmonary emboli. Anomaly of the IVC is a rare example of a congenital condition that predisposes to thromboembolism, presumably by favoring venous stasis. This diagnosis should be considered in patients under the age of 30 with spontaneous occurrence of blood clots.
Highlights
Over a century ago the German physician, Rudolf Virchow, was credited for elucidating the mechanism of pulmonary thromboembolism
The factors contributing to venous thrombosis came to be known as Virchow's triad
Due to the acute presentation of her venous thromboembolism, a left pelvic and lower extremity venous thrombectomy was performed. This was followed by stenting of a popliteal venous occlusion, and subsequent thrombolysis with tissue plasminogen activator
Summary
Over a century ago the German physician, Rudolf Virchow, was credited for elucidating the mechanism of pulmonary thromboembolism. The objective of this case report is to describe IVC malformation in a young patient as a risk factor in the development of venous thromboembolism and the associated clinical manifestations. This case provides the opportunity to review the dysregulated embryogenesis of this phenomenon, and the intricate management questions that arise. Due to the acute presentation of her venous thromboembolism, a left pelvic and lower extremity venous thrombectomy was performed This was followed by stenting of a popliteal venous occlusion, and subsequent thrombolysis with tissue plasminogen activator. The patient was kept on heparin for 24-hours and started on Coumadin
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