Infrarenal inferior vena cava agenesis

Abstract

We introduce the case of a 28-year-old male patient, who was admitted to the Vascular Department with a diagnosis of infrarenal inferior vena cava agenesis and secondary deep vein thrombosis (DVT) in the lower limbs (LL).

A 28-year-old male patient who came to the hospital’s Emergency Department due to non-specific abdominal discomfort described as "bloated feeling", dull pain in the mesogastrium and oedema in the LL during a month, for which he had consulted his primary care facility on several occasions.

Upon arrival at the Emergency Department, the physical examination revealed mild bilateral bimalleolar oedema, with no other significant findings. A complete blood test was performed, showing a D-dimer of 5,600 IU/l. In view of the suspicion of DVT in the LL, a Doppler echocardiography was performed, which reported filling defects inside the common femoral vein and both bilateral external and internal iliac veins. Due to these findings, he was admitted to the Vascular Department to complete the study.

During admission, an abdominal/pelvic CT scan was performed, showing the following results: absence of inferior vena cava at the infrarenal level, large amount of collateral circulation – especially paravertebral lumbar, multiple pelvic varicose veins and filling defects in the common bilateral external and internal iliac veins (Figure 1).

Given the aforementioned findings, treatment with low-molecular-weight heparins and subsequent anticoagulation therapy was started after hospital discharge.