Steven is an Advanced Trainee, dual training in General and Acute Care Medicine and Gastroenterology. He has worked at Auckland, Counties Manukau, and Waitemata District Health Boards. He is currently working at Waikato District Health Board.
Case Study: Lower Back Pain Leading To Incidental Diagnosis Of Inferior Vena Cava Thrombosis And Congenital Anomal
A fit 16-year-old man presented with presyncope and lower back pain. Initial assessment was unremarkable, but his back pain worsened over subsequent days with rising inflammatory markers. Eventually, spinal magnetic resonance imaging incidentally discovered inferior vena cava (IVC) thrombosis extending to bilateral popliteal veins; further imaging confirmed congenital IVC anomaly as the cause of thrombosis. He was treated with low-molecular-weight heparin and catheter-directed thrombolysis, followed by life-long dabigatran.
IVC thrombosis presents in various ways (Mcaree B, 2013). Non-specific lower back or abdominal pain can precede classically expected signs of lower limb deep vein thrombosis (DVT) in IVC thrombosis (Kraft C, 2013). It is important to recognise the correlation between congenital IVC anomalies and increased thrombotic risk due to increased venous pressures and stasis from restriction of venous channels (Mcaree B, 2013). Congenital IVC anomalies may be asymptomatic due to collateralisation, and may otherwise only be detected through incidental imaging (Mcaree B, 2013). However, these patients (especially males) can present in their third or fourth decades of life with IVC or bilateral lower limb thrombosis without apparent cause (Mcaree B, 2013), (Langer F, 2017).
Lower back or abdominal pain can precede usual DVT signs in IVC thrombosis (Kraft C, 2013). When young patients present with IVC or bilateral lower limb thrombosis, the possibility of underlying IVC anomaly should be considered (Langer F, 2017).
Kraft C, H. C.-L. (2013). Patients with inferior vena cava thrombosis frequently present with lower back pain and bilateral lower-extremity deep vein thrombosis. European Journal of Vascular Medicine, 275-283.
Langer F, S. D. (2017). Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain. Acta Médica Portuguesa, 333.
Mcaree B, O. M. (2013). Inferior vena cava thrombosis: A review of current practice. Vascular Medicine, 32-43.