Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 451  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  [PDF Not available] *
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed1319    
    Printed72    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal


 


 
ARTICLE
Year : 1977  |  Volume : 23  |  Issue : 1  |  Page : 33-34

Partial occlusion of the entire inferior vena cava


1 Bai Jerbai Wadia Hospital for children, Parel, Bombay-40012, India
2 K. E. M. Hospital, Parel, Bombay-40012, India
3 Radiation Medical Centre, Parel, Bombay-40012, India

Correspondence Address:
N P Vas
Bai Jerbai Wadia Hospital for children, Parel, Bombay-40012
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 615257

Rights and PermissionsRights and Permissions


 :: Abstract 

A patient with idiopathic partial occlusion of the entire inferior vena cava is described with results of hepatosplenic scintigraphy, radiology and necropsy.



How to cite this article:
Vas N P, Bhalerao R A, Pinto A, DaCosta H, Merchant S M. Partial occlusion of the entire inferior vena cava. J Postgrad Med 1977;23:33-4

How to cite this URL:
Vas N P, Bhalerao R A, Pinto A, DaCosta H, Merchant S M. Partial occlusion of the entire inferior vena cava. J Postgrad Med [serial online] 1977 [cited 2020 Feb 26];23:33-4. Available from: http://www.jpgmonline.com/text.asp?1977/23/1/33/42790



 :: Introduction Top


Idiopathic partial occlusion of the en­tire inferior vena cava (I.V.C.) is rare and we report. a child whose diagnosis was established antemortem and was subsequently confirmed at necropsy.


 :: Case report Top


The patient was a 7 year old boy who came with gradual distension of the ab­domen for two months. A month before the distension was noticed, he had jaundice, high fever and nausea for 5 days. On examination he was mal­nourished and weighed only 20 kg. in spite of considerable ascites. The liver extended 1 cm. below the right costal margin and the spleen was just palpable. Hepato-jugular reflux was doubtful; abdominal veins were not evident.

Laboratory investigations: Haemo­globin was 11 gm.% total leucocyte count was 7,800/c.mm. with 73% neutro­phils and 27% lymphocytes. Erythrocyte sedimentation rate (Wintrobe) was 28 mm hour and Mantoux reaction was strongly positive. Serum transaminases and liver function tests were normal. Serum albumin was 3.76 gm, %, and total serum globulin was 2.84 gm.% with grossly normal fractions. Bleeding and clotting times were normal. Ascitic tap revealed 112 cells/c.mm and 1600 mg.% proteins. No organisms were detected or cultured from the ascitic fluid, sputum or blood.

Radio-isotope study: The child was positioned supine under the 13" detector head of a Picker Dyna Scinticamera. the heart was partially inside the visual field, superiorly. Thus, the anatomic site of the entire I.V.C. and a small portion of the right iliac vein were covered by the detector. 2 mCi 99m Tc phytate was in­jected into the right malleolar vein (RMV) and scintiphotos were taken at approximately 1 sec. intervals for the first 20 sees. The dynamic study was then terminated and static hepatosplenic reticuloendothelial system (RES) scinti­photos were taken after 10 mins.

In normal subjects the I.V.C. see [Figure 1 A a] on page 34a is seen as a vessel of a uniform, appreciably sized calibre; the subsequent RES scan [Figure 1A b] at 10 mins. depicts normal liver and spleen. In this patient, only a trickle of the radio­pharmaceutical could pass through the I.V.C. [Figure 1B a] ; the right iliac vein appeared as a large vessel with collaterals arising from it (inferior corner). The static scintiphotos depicted uniform radio-­nucleide concentration in a single (uni­form) RES mass [Figure 1 B b] ; the spleen was grossly normal in size as seen in the right lateral view [Figure 1 B c] but it con­centrated more radio-colloid than nor­mal.

The hepato-biliary system was evaluat­ed by injecting 2 mCi 99m Tc pyridoxyl­idene glutamate intravenously. At 1 hour [Figure 1C a] some radioactivity was still in the heart, but the liver had con­centrated well; the 3 hour scintiphoto [Figure 1C b] depicted considerable excre­tion into the intestines. Thus, there was no obstruction in the biliary system.

Repeat study 2 months following inten­sive anti-tubercular therapy failed to reveal any change.

Radiocontrast study: In view of the radio-nucleide scintigraphic findings, a lack of change following anti-tubercular treatment and an increasing need for paracentesis, the child was transferred to the surgical unit where a classical radio­contrast inferior vena cavogram [Figure 2 A] confirmed partial occlusion of the I.V.C. with collateral circulation. A hepatogram [Figure 2 B] showed retro­grade filling of the portal vein instead of a normal entry of the material into the I.V.C.

Necropsy: The child expired suddenly while awaiting a venous graft. Necropsy revealed the IV.C. to be a fibrosed cord histologically composed of fibroblasts in­filtrated with a few small capillaries. The hepatic veins and their ostia were un­affected. The irregular liver showed mark­ed central venous congestion [Figure 2 C] as did all other organs which normally drain into the I.V.C. No etiology was dis­cernible for the considerably narrowed I.V.C. lumen. No other vessel revealed any occlusive changes and the peritoneum was normal although considerable free fluid was present.


 :: Discussion Top


The child presented as a case of mas­sive ascites requiring daily paracentesis. His liver function tests were normal except for a low albumin level. Ob­servation of radiopharmaceutical bolus under a scinticamera revealed the diag­nosis of partial occlusion of the entire I.V.C. without resorting to any invasive procedure; this diagnosis was not sus­pected but nucleovenography was done as a routine procedure during hepato­splenic scintigraphy. Budd Chiari syndrome is not rare and the I.V.C. ab­normalcy is secondary to a hepatic or renal pathology. [1],[2] In this instance how­ever, no other primary cause was deter­mined; there were no blood clots or malignant cells in the lumen of the vessel and no other artery or vein was similarly diseased. Deterioration in the child's condition spelt progression of the lesion, yet no signs of infection, inflammation or collagen deposition were seen at necropsy. Furthermore, the entire vessel was uniformly affected.

 
 :: References Top

1.Bras, G.: Aspects of hepatic vascular disease in "Liver" 1973, p. 406. Ed. E. Gall and F. Mostoffi. Williams & Wilkins, Balti­more.  Back to cited text no. 1    
2.Sherlock, S.: Diseases of the liver and biliary system. 1968, p. 245. Ed. S. Sher­lock, Blackwell Sc., London.  Back to cited text no. 2    


    Figures

  [Figure 1 A a], [Figure 1A b], [Figure 1B a], [Figure 1 B b], [Figure 1 B c], [Figure 1C a], [Figure 1C b], [Figure 2 A], [Figure 2 B], [Figure 2 C]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow