Thrombosis of the inferior vena cava by a testicular tumour

We report on an unusual case of testicular tumour presenting as thrombosis of the inferior vena cava. The inferior vena cava thrombosis due to tumour invasion is a rare presentation of testicular tumour. After four cycles of chemotherapy, the tumour which invaded and obstructed the vena cava was replaced by scar tissue.     

下腔静脉滤器继发血栓形成

目的探讨下腔静脉滤器继发血栓形成的预防及治疗. 方法总结2001年12月～2004年6月我院7例下腔静脉继发血栓形成的治疗经验. 结果手术取栓2例,介入吸栓、溶栓1例,保守治疗4例,均取得一定疗效,治疗过程中未发生肺栓塞. 结论严格掌握放置下腔静脉滤器适应证、辅助抗凝治疗是预防滤器继发血栓形成的根本措施,介入是治疗滤器血栓形成的最佳选择.     

Dual inferior vena cava: two inferior vena cava filters

The formation of the venous drainage system of the human body is a complex process involving structures forming and regressing in a predefined order. Interruption of any one of these steps results in the formation of a congenital anomaly. Knowledge of these anomalies can prevent us from potential serious and sometimes fatal complications. Variations from the normal anatomy of the inferior vena cava (IVC) occur in 3% of the population. The complex embryology of the IVC stems from three pairs of fetal veins: (1) posterior cardinal veins, (2) subcardinal veins, and (3) supracardinal veins. The cardinal veins constitute the main venous drainage system of the embryo. Although venous anomalies are rare, their knowledge is crucial in diagnosis and treatment. These variations should not be mistaken for pathologic finding, but should be viewed as normal findings of abnormal embryogenesis. We present a case here identifying a dual IVC, subsequently leading us to place two IVC filters.     

Perinatal inferior vena cava thrombosis and absence of the infrarenal inferior vena cava

We report a case of infrarenal absence of the inferior vena cava (IVC) presenting as a major iliofemoral deep venous thrombosis in an adolescent. This is the first report of infrarenal IVC absence in which IVC thrombosis has been demonstrated in the perinatal period. We propose an association between perinatal IVC thrombosis and subsequent infrarenal IVC absence. In addition, the case demonstrates the importance of assessment for anatomical anomalies in patients presenting with apparently idiopathic deep venous thrombosis.     

Resection of the inferior vena cava for lumbar metastasis of a seminoma of the ovary

A case of lumbar metastasis of a seminoma of the ovary is presented. Resection of the tumor with the attached inferior vena cava below the right renal vein was carried out, followed by 4000 rad therapy.The phlebographic study shows the importance of lumbar veins and left gonadal vein in the returning venous blood after the resection of the inferior vena cava.Fifteen years after the operation the patient is in good physical state. The case is a proof for aggressive surgical management in such conditions.     

Double inferior vena cava

Venous anomalies involving the inferior vena cava are very rare. The case of a 74-year-old man with coronary artery disease is presented. Interestingly, a double inferior vena cava was incidentally discovered during coronary artery bypass grafting. Persistence of the left hepatic segment vein appeared as a left inferior vena cava-a very rare condition.     

Injuries of the inferior vena cava

The treatment of 77 patients with wounds of the inferior vena cava admitted to Grady Hospital, Atlanta, Georgia, from January 1972 through December 1983, was reviewed. All injuries were identified by laporotomy and/or thoracotomy. Trauma resulted from gunshot wounds in 79 per cent of patients, stab wounds in 18 per cent, and blunt trauma in 3 per cent, with an overall mortality of 30 per cent. The chief determinates of survival were preoperative hypotension, location of the injury and the presence of other major vascular injuries. Of the 49 patients admitted in shock, 22 (45%) died, all of complications related to organ ischemia. Only one patient not hypotensive on admission succumbed. Of the 29 patients with at least one additional injury to a major vascular structure, 45 per cent died. The mortality of infrarenal and suprarenal injuries was relatively low (22% and 33% respectively), compared with retrohepatic and supradiaphragmatic injuries, both of which were fatal in 67 per cent of the cases. Despite advances in the care of the trauma patient, significant improvement in survival has not occurred, and the patient mortality has remained at 30 per cent.     

Aneurysms of the inferior vena cava

Aneurysms of the inferior vena cava are very rare. We describe a case of a saccular aneurysm of the inferior vena cava that thrombosed after vigorous exercise. This presented as deep venous thrombosis associated with a retroperitoneal mass. Laparotomy with biopsy confirmed the benign nature of this lesion, and symptoms gradually resolved. It is hypothesized that the increased intraabdominal pressure during exercise led to the thrombosis of what is presumed to be a congenital aneurysm of the inferior vena cava.     

Anomalies of the inferior vena cava

The inferior vena cava is formed by a complex process of embryogenesis during the sixth to tenth week of gestation. Improper completion of the process may result in four anatomic anomalies: duplication of the inferior vena cava, transposition or left-sided inferior vena cava, retroaortic left renal vein, and circumaortic left renal vein. The first two anomalies can be diagnosed by sonography and all four anomalies can be seen on CT scan of the abdomen. Duplication and transposition of the inferior vena cava should be further delineated by preoperative phlebography. Preoperative diagnosis of the anomalies should reduce the complication rate of abdominal aortic operations.