Abstract
IVC thrombosis is often under-recognized. Malignancy can cause spontaneous IVC thrombosis due to its prothrombotic potential. Malignant tumors can compress, adhere or infiltrate the IVC wall causing endothelial damage with subsequent thrombosis. Retroperitoneal lymphadenopathy can cause compressive distortion of IVC causing venous stasis and turbulent flow. Metastatic retroperitoneal lymphadenopathy from testicular tumor is a rare cause of IVC invasion with resultant IVC thrombosis which can rarely present as backache. High index of suspicion is needed to detect primary testicular tumor in cases of IVC thrombosis, especially in young individuals.
 A 26 -year old male presented with lower back ache, weight loss and fever. MRI Lumbosacral spine done outside showed a soft tissue signal intensity retroperitoneal mass in aortocaval region compressing IVC. Ultrasound (done outside) revealed mild right sided hydroureteronephrosis secondary to a lobulated heterogeneous mass in inter-aortocaval region encasing right ureter and invading IVC causing thrombosis. Contrast enhanced Computerized axial tomography of abdomen showed a heterogeneously enhancing lobulated mass with multiple internal calcifications, in inter-aortocaval region at L3-4 level invading the IVC causing IVC thrombosis. Both tumor thrombus and bland thrombus were present. The right testis showed a subtle 10x10 mm hypodense lesion with peripheral calcification. DW-MRI showed diffusion restriction in retroperitoneal mass and the IVC tumor thrombus. Possibility of primary testicular tumor with metastatic retroperitoneal lymphadenopathy causing IVC invasion with resultant thrombosis was considered which was confirmed on histopathology examination.
Highlights
The prevalence of thrombosis is higher in renal cell carcinoma (RCC) as compared to retroperitoneal, hepatocellular carcinoma (HCC) and metastatic liver tumors
Acquired IVC thrombosis occurs due to spontaneous thrombosis in normal vessel, thrombosis secondary to external vascular compression or due to pathological changes in the vessel wall [8]
Spontaneous IVC thrombosis in malignancy occurs due to prothrombotic potential of the tumor with radiotherapy and chemotherapy treatment which enhance the risk of thrombosis
Summary
A 26 years old male patient presented with lower back ache, weight loss and fever. MRI Lumbosacral spine (Fig. 1) done in an outside center showed a soft tissue signal intensity retroperitoneal mass in aorto-caval region compressing IVC- likely lymph nodal mass. A lobulated mixed echoic mass of size 84x76x57 mm noted in retroperitoneum in inter-aortocaval region proximal to level of aortic bifurcation extending to pre-aortic and pre-caval region (Fig. 2 A-B) It showed few echoreflective foci of calcification. USG of right testis (Fig. 2 C-D) showed a well-defined mixed echoic solid mass measuring 18 (length) x14 (anteroposterior) x15 (transverse) mm showing peripheral echoreflective calcification in its posterior portion Liver and both adrenal glands appear normal. 77 (length) x22(anteroposterior) x24(transverse) mm was noted in adjoining IVC extending proximally upto opening of bilateral renal veins in IVC showing heterogeneous post contrast enhancement. This was likely to represent tumor thrombus. Findings were suggestive of metastatic deposits of non seminomatous malignant germ cell tumor (predominantly yolk sac tumor component)
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