Pulmonary Embolism in a Patient with Dual Inferior Vena Cava

Dual inferior vena cava (DIVC) is a rare congenital anomaly complicating venous thromboembolism (VTE) management. This report describes a 59-year-old male with right lower extremity deep vein thrombosis and extensive pulmonary embolism. A DIVC was incidentally discovered during endovascular evaluation prompted by an atypical catheter trajectory, which precluded standard inferior vena cava filter placement. The patient was successfully managed with targeted catheter-directed thrombolysis for a significant embolic burden in the pulmonary artery. This case highlights the diagnostic and therapeutic challenges of DIVC, underscoring the need for a high index of suspicion for venous anomalies to guide individualized treatment in patients with extensive thromboembolic disease.