OBSTRUCTION OF THE INFERIOR VENA CAVA IN CHILDHOOD

Abstract

FORTY-THREE cases of obstruction of the inferior vena cava in childhood have been found in a search of the English literature, more than one-half of them collected by Pleasants in 1911 (Table I). Of the total cases, 13 survived the disease; 9 of these were congenital in origin. Only three had demonstration of the obstruction by venography; of these, two were congenital and did not reveal any deep collateral circulation. The most common factors in the etiology were infection, congenital obliteration of the inferior vena cava with anomalous drainage, and thrombus or invasion of the vessel by a malignant tumor (Table II). Sequelae varied with the particular etiology of the obstruction, the acuteness of onset, the location, and the rapidity of its progression (Table III). CLINICAL MANIFESTATIONS The most common symptoms of this condition are found to be inconstant pain generally referred to the lumbar area, edema of the legs when the iliac veins are also obstructed, and the presence of superficial collateral circulation. Ascites, jaundice hemorrhoids and splenomegaly are uncommon and dilated superficial veins do not appear unless other deep veins are also obstructed. Marked albuminuria or oliguria which was not present previously may suggest the progression of the process to involve the renal vein. Almost complete anuria may supervene before adequate collateral circulatory adjustment takes place. When the lower third of the inferior vena cava is obstructed, collateral circulation is usually evident in the groin, abdomen and flank. Albuminuria is rare, edema of the abdominal wall is unusual, and edema of the legs is usually absent unless there is concomitant obstruction of the iliac vein.