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Erschienen in:
03.01.2019 | Images in Anesthesia
Congenital absence of the inferior vena cava
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 4/2019
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A 48-yr-old man was scheduled for dental extractions under general anesthesia. He had been on rivaroxaban for ten months (having been on warfarin for the prior three decades) because of multiple episodes of deep vein thrombosis (DVT) and pulmonary embolism. These episodes had occurred despite continuous anticoagulation and use of anti-embolic stockings. Physical examination revealed lower limb congestion with pitting edema, venous varicosities, stasis dermatitis, skin ulceration (Figure A), as well as some dilated and thrombosed superficial abdominal veins.
Figure
A) Photograph of the patient with congenital absence of the inferior vena cava (IVC) shows edema, stasis dermatitis, and trophic skin changes resulting from chronic venous congestion. B) Coronal delayed-phase (with contrast) computed tomography of the abdomen shows the absence of the IVC, with retroperitoneal collateral vessels (white arrows) surrounding the abdominal aorta (asterisk) and the opacified ureters (black arrowheads). The inferior mesenteric vein (black arrow) is dilated, related to collateralization with systemic venous drainage to the portal venous system. Superficial collateral vessels are also noted (white arrowheads). B = urinary bladder
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