March/April - West Virginia State Medical Association

Scientific Article |
Congenital Absence of Inferior Vena Cava with
Idiopathic Deep Vein Thrombosis in an Adult
Deepak Hooda, MD, MPH
Fellow, WVU Heart Institute, Morgantown
Karthik Penumetsa, MD
Resident, Department of Medicine, WVU, Morgantown
Timothy Jackson, MD
Section Chief, Associate Professor of Medicine (SOM),
WVU, Morgantown
Wissam Gharib, MD
Associate Professor of Medicine (SOM), WVU Heart
Institute, WVU, Morgantown
Robert J. Beto, MD
Associate Professor of Medicine (SOM), WVU Heart
Institute,WVU, Morgantown,
Bradford E. Warden, MD
Program Director (Cardiology), Associate Professor of
Medicine (SOM), WVU Heart Institute,WVU,
Morgantown
Acknowledgement: Masroor
Abro MD, Fellow WVU Heart
Institute, Morgantown WV.
Corresponding Author: Deepak Hooda, MD MPH, 1
stadium drive, WVU Hospitals, Morgantown WV 26506
deepak.hooda@gmail.com.
Introduction
Deep vein thrombosis (DVT)
is rare in younger patients, with
a prevalence of 1:10,000. 1 In this
patient population congenital
absence of inferior vena cava
(CAIVC) is an anomaly which
has been recognized as a rare
inherited risk factor for DVT. 2 Such
patients are often asymptomatic
and are diagnosed incidentally.
In a young patient with a new DVT
and no risk factors, it is important to
consider congenital anomalies in the
differential diagnoses. We describe
a case of CAIVC and condition
that is often underreported due
to lack of diagnostic accuracy.
except smoking noted gradual
onset of lower back pain and
bilateral lower limb swelling for
the past four weeks. On arrival he
was wheelchair bound. He had no
family history of clotting disorders,
congenital defects or autoimmune
diseases. After admission he
underwent extensive investigation
including a hypercoagulopathy
panel, prothrombinII gene
mutation, Methylenetetrahydrofolate
reductase(MTHFR) gene mutation,
homocystein, factorV leiden
mutation, Beta2 glycoprotein IgA/
IgM, anticardiolipin IgG/IgM, lupus
anticoagulant IgG/IgM, protein C&S
antigen/functional levels, CD55&CD59
antibodies and antithrombinIII
antibodies. These tests were all
negative. Subsequently a Doppler
ultrasound of the lower limbs
revealed extensive bilateral common
femoral, superficial femoral,
popliteal, posterior tibial and greater
saphenous vein thromboses.
A computed tomography (CT)
scan of the abdomen/pelvis with
intravenous contrast revealed
thrombosis of the distal inferior
vena cava (IVC) and iliac veins with
a congenital absence of suprarenal
and intrahepatic segments of
the IVC (Fig1&2) with extensive
collaterals and prominent ascending
lumbar, perivertebral, azygous and
hemiazygous venous systems. The
patient was started on coumadin
for long term anticoagulation.
The patient was followed up in
3 months and subsequently six
months after hospitalization with
complete resolution of symptoms
and bilateral lower limbs swelling.
Discussion
DVT is rare in the young. It may
occur due to underlying acquired
Figure 1.
CT chest abdomen pelvis sagittal view: absent segment of IVC (arrow).
Case report
A twenty-year-old athletic male
with no relevant medical history
28 West Virginia Medical Journal