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Current Medical Imaging

Author(s): Clinton Yeaman*, Adithya Peruri, Tania Rodriguez-Carpio, Aditya Sharma, Randy Ramcharitar, Tracey Krupski and Minhaj Khaja

DOI: 10.2174/1573405617666210623152051

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Inferior Vena Cava Thrombus Secondary to Ureteropelvic Junction Obstruction with Severe Hydronephrosis

Article ID: e230621194231 Pages: 4

  • * (Excluding Mailing and Handling)

Abstract

Background: Benign external compression of the Inferior Vena Cava (IVC) with distal thrombus formation is seldomly described in the medical literature.

Case Presentations: We report a case of external IVC compression by a dilated right renal pelvis and hydronephrotic kidney secondary to longstanding Ureteropelvic Junction (UPJ) obstruction found in a 68-year-old male. Management included therapeutic anticoagulation, IVC filter placement, attempted thrombectomy by interventional radiology, and interval repeats imaging. This patient demonstrated complete resolution of the caval thrombus on repeat imaging 2 months following discharge. This case highlights the importance of interdisciplinary team coordination, a crucial component of patient’s management and eventual treatment plan. It is reasonable to manage patients with IVC thrombus with anticoagulation alone.

Conclusion: In the modern era, angiointerventional techniques provide minimally invasive approaches to the management of vascular disorders and minimize morbidity.

Keywords: Inferior vena cava, thrombosis, hydronephrosis, ureteral obstruction, anticoagulation, radiology.

Graphical Abstract

[1]
Aliotta PJ, Lacey SR, Allen JE, Greenfield SP. Giant hydronephrosis presenting as unilateral iliofemoral vein thrombosis. J Urol 1988; 139(5): 1035-6.
[http://dx.doi.org/10.1016/S0022-5347(17)42761-3] [PMID: 3361637]
[2]
Neheman A, Shumaker A, Levin D, et al. Robot-assisted laparoscopic pyeloplasty for “huge” hydronephrosis causing vena cava thrombus. Urology 2019; 133: 240.
[http://dx.doi.org/10.1016/j.urology.2019.08.024] [PMID: 31465792]
[3]
Davis GC, Aronson NE, Moul JW. Inferior vena cava compression due to massive hydronephrosis from bladder outlet obstruction. Tech Urol 2000; 6(3): 226-7.
[PMID: 10963496]
[4]
Asanad K, Nassiri N, Vasquez E. Severe ureteropelvic junction obstruction with massive hydronephrosis causing compression of the inferior vena cava. Urol Case Rep 2020; 32: 101272.
[http://dx.doi.org/10.1016/j.eucr.2020.101272]
[5]
Gaur D, Dubey , Acharya . Successful management of vena caval compression due to a giant hydronephrosis by retroperitoneoscopic nephrectomy. Minim Invasive Ther Allied Technol 2003; 12(1): 95-7.
[http://dx.doi.org/10.1080/13645700310004330] [PMID: 16754085]
[6]
Zahid M, Nepal P, Nagar A, Ojili V. Abdominal vascular compression syndromes encountered in the emergency department: Cross- sectional imaging spectrum and clinical implications. Emerg Radiol 2020; 27(5): 513-26.
[http://dx.doi.org/10.1007/s10140-020-01778-1] [PMID: 32307633]
[7]
England RA, Wells IP, Gutteridge CM. Benign external compression of the inferior vena cava associated with thrombus formation. Br J Radiol 2005; 78(930): 553-7.
[http://dx.doi.org/10.1259/bjr/21010811] [PMID: 15900063]