Suppurative Thrombophlebitis of the Inferior Vena Cava Resolved with Intravenous Antibiotic Therapy: A Case Report
Inferior vena cava (IVC) thrombosis is a rare medical condition. Suppurative thrombophlebitis of the IVC is even a more uncommon subtype of IVC thrombosis and is mostly associated with IVC filters or venous catheters. We describe a 66-year-old man with persistent fever and history of pyonephrosis secondary to transurethral lithotripsy 1 month before recent admission. Computed tomography scan of the chest and abdomen revealed a filling defect in the IVC protruding into the right atrium. Transesophageal echocardiogram (TEE) revealed a large mass at the origin of the IVC entering into the right atrium, suggestive of a clot.
Diagnosis of suppurative thrombophlebitis of the IVC secondary to a retroperitoneal abscess was made, and intravenous antibiotic therapy for 6 weeks without anticoagulation conferred ample thrombus resolution. Follow-up TEE in week 16 showed no residual thrombus in the IVC.
Shi W, Dowell JD. Etiology and treatment of acute inferior vena cava thrombosis. Thromb Res 2017;149:9-16.
Strinden WD, Helgerson RB, Maki DG. Candida septic thrombosis of the great central veins associated with central catheters. Clinical features and management. Ann Surg 1985;202:653-658.
Andes DR, Urban AW, Acher CW, Maki DG. Septic thrombosis of the basilic, axillary, and subclavian veins caused by a peripherally inserted central venous catheter. Am J Med 1998;105:446-450.
Bassilios N, Tassart M, Restoux A, Bigot JM, Rondeau E, Sraer JD. Inferior vena cava thrombosis due to acute pyelonephritis. Nephrol Dial Transplant 2004;19:981-983.
Eijsten A, Leisinger HJ, Jucker A. Unilateral pyonephrosis with septic thrombosis of the renal vein and vena cava. Urol Int 1986;41:77-79.
Kniemeyer HW, Grabitz K, Buhl R, Wüst HJ, Sandmann W. Surgical treatment of septic deep venous thrombosis. Surgery 1995;118:49-53.
Soler R, Rodríguez E, López MF, Marini M. MR imaging in inferior vena cava thrombosis. Eur J Radiol 1995;19:101-107.
Villani C, Johnson DH, Cunha BA. Bilateral suppurative thrombophlebitis due to Staphylococcus aureus. Heart Lung 1995;24:342-344.
Alkhouli M, Morad M, Narins CR, Raza F, Bashir R. Inferior Vena Cava Thrombosis. JACC Cardiovasc Interv 2016;9:629-643.
Copyright (c) 2018 The Journal of Tehran University Heart Center
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.