Abstract | November 8, 2021

Bilateral Lower Extremity Deep Venous Thrombosis Secondary to Congenital Inferior Vena Cava Hypoplasia

Presenting Author: Leela Kantamnenil, MD, Internal Medicine PGY3, Department of Internal Medicine, UAB Huntsville Regional Medical Campus, Huntsville, Alabama

Coauthors: Leela Kantamneni, MD, Internal Medicine PGY 3, UAB Huntsville Regional Medical Campus, Huntsville, Alabama; Rachel Kruspe, MD Associate Professor, Hematology-Oncology, The Cancer Center, Huntsville Hospital, Huntsville, Alabama; Farrah Ibrahim, MD, Program Director Internal Medicine, UAB Huntsville Regional Medical Campus, Huntsville, Alabama.

Learning Objectives

  1. Identify an unusual cause leading to bilateral lower extremity deep venous thrombosis in the young. 
  2. Treat massive deep venous thrombosis for appropriate duration and choice of agent. 

Introduction: Congenital malformations of the inferior vena cava are a known but rare cause of deep venous thrombosis (DVT). Usually presented in the mid-twenties with recurrent or bilateral DVTs. This is a case of bilateral DVT in a young male without any known inherited thrombophilia. 

Case presentation: A 17-year-old Puerto Rican male with no known medical problems and a recent appendectomy presented to the Emergency Department with persistent fever and groin pain despite antibiotics. On exam, he was hemodynamically stable his bilateral lower extremities were mildly tender with 1+ pedal edema and reduced sensation. Labs were significant for anemia Hb 10 mg/dl, wbc 8 x 10 ^3 /mcL, plt 285 x 10 ^3 /mcL, INR 1.3, PTT 40 sec, fibrinogen 127 mg/dl rest unremarkable. He was diagnosed with bilateral lower extremity DVT via CT abdomen/pelvis which showed bilateral iliac, femoral vein thrombi, and congenital hypoplastic infrarenal IVC with azygos and hemi-azygos collateralization. He underwent thrombolysis with TPA via infusion catheters and was transitioned to heparin drip after completion. 

Final diagnosis: Bilateral lower extremity deep venous thrombosis 

Management: Life-long anticoagulation was initiated with Xarelto due to an increased propensity to form thrombi. The patient was also referred to Vascular surgery for IVC reconstruction.

Download Abstract
Back to Abstracts