Acute Budd-Chiari syndrome due to inferior vena cava occlusion following blunt trauma

Thrombectomy under Cardiopulmonary Bypass for Inferior Vena Cava Thrombosis Induced by Liver Injury

Inferior vena cava thrombosis (IVCT) caused by liver injury is a rare and challenging condition. A 32-year-old man sustained a severe liver injury in a traffic accident. Emergent thromboembolic procedure for the affected hepatic arteries was performed for hemostasis, resulting in hemodynamic stabilization of the patient. One month later, however, computed tomography (CT) showed liver congestion caused by IVCT from the suprahepatic IVC to the bilateral common iliac veins. As liver function deteriorated quickly despite heparin administration, surgical thrombectomy was performed under hypothermic circulatory arrest through sternotomy and laparotomy. After this operation, the liver was decongested and its function improved rapidly.

Successful surgical treatment of chronic inferior vena caval thrombosis following blunt trauma

Posttraumatic inferior vena cava (IVC) thrombosis is extremely rare. We report a case of surgical treatment for chronic inferior vena caval thrombosis 4 years after blunt trauma. A 22-year-old man was referred to our hospital for investigation of an inferior vena caval thrombosis. He had a history of blunt abdominal trauma at age 18 while dismantling a medium truck and had undergone pancreaticojejunostomy for a pancreatic laceration. Computed tomography (CT) scans revealed an inferior vena caval thrombosis extending into the right atrium. Lung perfusion scintigraphy was unremarkable. We performed thrombectomy through a median sternotomy under deep hypothermic circulatory arrest, which gave adequate visualization in a bloodless field. A fiberscope was used intraoperatively for detailed IVC inspection. Postoperative recovery was uneventful, and he was discharged on the 14th postoperative day. Postoperative CT and echocardiography showed no recurrence of the thrombosis.

[Traumatic thrombosis of the inferior vena cava]

Traumatic thrombosis of vena cava is rare. Thrombosis of the inferior vena cava diagnosed by uroscanner after blunt abdominal trauma involving the kidney is reported. The Doppler exam confirmed the floating character of the clot. Three days after the initiation of anticoagulant therapy, the thrombus disappeared without any clinical or radiological signs of pulmonary embolism. Fifteen cases of traumatic thrombosis of the inferior vena cava have been described in the literature. Mechanisms, clinical pictures and the management are discussed.

Budd-Chiari syndrome: combination of genetic defects and the use of oral contraceptives leading to hypercoagulability

A young female, who had been in excellent health and had used third-generation oral contraceptives, was admitted to hospital because of abdominal pain and ascites. Budd-Chiari syndrome (BCS) was diagnosed by radiographic and histological examination. Tests for myeloproliferative disease, deficiency of coagulation inhibitors and paroxysmal nocturnal haemoglobinuria were negative. DNA investigation showed a double heterozygous defect: the Arg506Gln mutation in the factor V gene (factor V Leiden) and G20210A nucleotide substitution in the prothrombin gene. This double defect was also found in the patient's father, who had never experienced an episode of venous thromboembolism. Genetic and acquired thrombogenic risk factors are being detected increasingly in patients with BCS. With the discovery of new genetic defects leading to hypercoagulabiulity an increasing number of patients with serious thrombotic manifestations, such as BCS, will exhibit concurrence of hereditary and acquired risk factors for thrombosis.

Resection of a pulmonary malignancy invading the intrapericardial inferior vena cava

Resection of extensive lung cancers invading thoracic vascular structures (T4 lesions) can yield long-term survival provided the margins and nodes are free of tumor. We report the resection of the suprahepatic inferior vena cava for direct tumor involvement by a pulmonary malignancy. The resection was performed without bypass, and the cava was subsequently reconstructed with a 22-mm-diameter Dacron graft. Patency was documented on postoperative magnetic resonance angiograms. The patient was discharged home on postoperative day 10 without complications and remains well 8 months after the operation. Potentially curative resections and reconstructions of suprahepatic inferior vena cava involved with pulmonary malignancies are possible and can be done without cardiopulmonary bypass.

Budd-Chiari syndrome resulting from intrahepatic IVC compression secondary to blunt hepatic trauma

Hepatic venous outflow obstruction (Budd-Chiari syndrome)is a rare sequel of abdominal trauma. Three cases of Budd-Chiari syndrome resulting from obstruction to the intrahepatic IVC by liver injury are reported. The CT findings include extrinsic compression of the intrahepatic inferior vena cava (IVC) by intraparenchymal and/or subcapsular hepatic haematoma, non-visualization or narrowing of one or more main hepatic veins with intravenous contrast-enhanced CT, and accumulation of low attenuation ascites. This entity should be distinguished from intraperitoneal bile leak or hemoperitoneum associated with major liver injury with which it could be confused. Decompression of the IVC and hepatic veins by surgical or percutaneous drainage of intrahepatic or subcapsular hematoma was curative in two of the three patients.