Azygous collateral thrombosis presenting as ureteric colic
Todd Smith1, Anoop Prasad, Tristan Lane
1Department of Vascular Surgery, Charing Cross Hospital, Imperial NHS Healthcare Trust, London, UK. todd.smith@imperial.nhs.uk
Vascular and Endovascular Surgery
|July 1, 2011
Summary
A young man with leg swelling experienced flank pain and blood in urine, revealing an abnormal vein structure (azygous continuation of the inferior vena cava). This rare vascular anomaly required lifelong anticoagulation for treatment.
Area of Science:
- Vascular Surgery
- Radiology
- Internal Medicine
Background:
- Inferior vena cava (IVC) anomalies are rare congenital conditions.
- Azygous continuation of the IVC can present with diverse clinical symptoms.
Observation:
- A 33-year-old male presented with hematuria and left loin pain radiating to the groin.
- Physical examination revealed signs of chronic venous insufficiency in the lower limbs.
- Imaging demonstrated an enlarged azygos vein, suggesting azygos replacement of the IVC, and extensive pelvic/abdominal venous collaterals.
Findings:
- Computed tomography (CT) urogram and CT thorax/abdomen/pelvis identified an aberrant venous system.
- A left para-aortic lesion was characterized as a thrombosed collateral vessel.
- Ultrasound and MRI confirmed the diagnosis of a thrombosed collateral associated with aberrant venous web drainage.
Implications:
- This case highlights the importance of advanced imaging in diagnosing rare vascular anomalies.
- Management involved lifelong anticoagulation to address the thrombosed collateral and prevent further complications.
- Understanding such venous anomalies is crucial for appropriate clinical management and patient outcomes.
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