An unusual case of inferior vena cava thrombosis: widening the differential diagnosis

Excerpt

A 46-year-old woman was referred to the Emergency Room of our hospital because of incidental finding of “fluctuant thrombus” in the inferior vena cava (IVC) during a routine abdomen US (Fig. 1a) performed for the follow-up of chronic HBV and HCV infection without evidence of active hepatitis. The patient was essentially asymptomatic, apart from a mild bilateral edema of the legs, started 2 weeks before, with no limitation of daily activities. She denied dyspnea, chest, abdominal or leg pain, palpitations or syncope. Her clinical history revealed smoking habit, previous hysteroannessiectomy for multiple large myomas 10 months before, and no personal or family history of previous thrombosis. She took no daily therapy and had no history of drug abuse. She contracted HBV and HCV infections from her husband, who, in turn, contracted both infections from blood transfusions. Her vital signs were normal, in particular neither tachycardia nor hypotension was noted. Her physical examination detected only a mild bilateral edema of the legs without palpable venous cords. ECG showed normal sinus rhythm with no S1Q3T3 pattern. CT pulmonary angiography ruled out pulmonary embolism, and, remarkably, lower extremities venous Duplex US was negative for thrombosis. Laboratory tests showed C-reactive protein, complete blood counts, renal function, prothrombin time and activated thromboplastin time within the limits. A provisional diagnosis of IVC thrombosis not datable was made, i.v. unfractionated heparin was started and the patient was admitted to our department for further studies.

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