Thrombosed aneurysm of the infrarenal vena cava: diagnosis and treatment

Aneurysms of the inferior vena cava are rare. Usually they are diagnosed incidentally or due to the patient having suffered thromboembolic complications. We report one case of a patient admitted due to deep vein thrombosis of his left lower limb in whom a thrombosed mass of the infrarenal vena cava and of both proximal common iliac veins was detected by duplex, CT scan and MRI. The additional information obtained by the phlebography showed abundant collateral circulation via ascending lumbar veins, suggesting gradual occlusion rather than sudden thrombosis. Guided biopsy was not contemplated and the patient underwent surgery with a diagnosis of thrombosis of the infrarenal vena cava due to suspected malignancy versus aneurysm. Intraoperative anatomopathological examination revealed no evidence of malignancy and partial resection with infrarenal vena cava ligation was performed. After six months the patient remains well under oral anticoagulation. On the basis of the literature and taking into account this case, the management of aneurysms of the inferior vena cava when they have already suffered thrombosis should include open surgery which allows us to make the diagnosis with certainty and treatment of the patient.