SONOWORLD : Thrombus in the inferior vena cava

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Vascular » Visceral vascular

Thrombus in the inferior vena cava

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Author(s) :

Chaitali Shah, FRCR

Presentation A 63 year old woman with a history of systemic lupus erythematosus, lupus nephritis, cardiac mural thrombus and recurrent lower limb venous embolisms presents with chronic vague pain in the mid-abdomen. The patient also gives a history of an interventional vascular procedure.

Caption: Transverse midline image.

Description: The inferior vena cava shows the presence of echogenic material within its lumen. The left renal vein is visualized in this image crossing the midline, and it appears normal.

Caption: Sagittal scan to the right of the midline.

Description: There is focal expansion of the inferior vena cava by the echogenic thrombus, which partially fills its lumen. Parallel, highly-reflective bright lines are seen at the distal end of the thrombus. These represent a filter in the cava.

Caption: Sagittal color Doppler image.

Description: The lumen of the IVC shows incomplete filling of color.

Caption: Transverse color Doppler image.

Description: This image also depicts the incomplete filling of color within the lumen of the IVC due to the presence of thrombus.

Differential Diagnosis Thrombus in the inferior vena cava in a patient with lupus.

Final Diagnosis

Thrombus in the inferior vena cava in a patient with lupus. The bright parallel echoes represent parts of a filter in the IVC that was placed secondary to repeated lower limb thrombosis in order to prevent pulmonary emboli.

Follow Up This patient was started on oral anticoagulation therapy and is currently doing well.