Hypoplasia of the inferior vena cava and deep vein thrombosis

A 61-year-old man presented with spontaneous bilateral ilio-femoral DVT and dyspnea. His past medical history was unremarkable, and there was no familial history for venous thromboembolism. Laboratory studies did not reveal any thrombophilic defect, whereas a CT (Figure 1A) and MRI (Figure 1B–D) of the abdomen showed marked hypoplasia of the suprarenal tract of the IVC (arrowhead), which appeared extensively thrombosed (arrow) in the portion distal to the atresic tract. Venous drainage from the inferior part of the body was accomplished by a dilated azygos and paravertebral veins (stars). A CT pulmonary angiogram excluded pulmonary embolism (PE). The patient was treated with full dose low-molecular-weight heparin and warfarin and discharged. ... Hypoplasia of the IVC should be taken into account when otherwise unexplained DVT developed in people under 50 years of age;1 it is exceptional in older ages, such is in this case. Tips for diagnosis are the presence of extensive and bilateral iliac thrombosis, an enlarged shadow of the azygos vein on chest X-rays and associated cardiac and visceral abnormalities, such as destrocardia, pulmonary stenosis, atrial defects, polisplenia, asplenia or situs inversus.2