Inferior vena cava thrombosis-rope ladder sign
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Updated: Oct 17, 2025
Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
1Department of Pediatrics and Neonatology, University Children's Hospital of Saarland, 66421, Homburg, Germany. sascha.meyer@uks.eu.
Insights
This study reports on an infant with congenital univentricular heart disease who developed inferior vena cava (IVC) thrombosis after surgery. The infant was treated with aspirin and clopidogrel.
Area of Science:
- Pediatric Cardiology
- Vascular Complications
Background:
- Congenital heart disease affects ~1% of births, posing long-term care challenges.
- Complex congenital heart disease requires ongoing management due to potential complications.
Purpose of the Study:
- To report a case of post-operative inferior vena cava (IVC) thrombosis in an infant with congenital univentricular heart disease.
- To describe the diagnostic findings and initial management of this rare complication.
Main Methods:
- Case report of a 17-month-old infant with congenital univentricular heart disease.
- Diagnostic imaging using bedside contrast media study (X-ray) to confirm IVC thrombosis.
- Assessment of collateral circulation patterns, including the "rope ladder sign".
Main Results:
- Post-operative inferior vena cava (IVC) thrombosis was diagnosed in the infant.
- Contrast study revealed collateral paravertebral circulation (rope ladder sign) and absent IVC contrast.
- The infant was initiated on dual antiplatelet therapy with aspirin and clopidogrel.
Conclusions:
- Inferior vena cava (IVC) thrombosis is a potential post-operative complication in complex congenital heart disease.
- Early diagnosis via imaging and prompt anticoagulation/antiplatelet therapy are crucial for management.
- This case highlights the importance of vigilant monitoring for vascular complications in pediatric cardiac surgery patients.
Abstract:
Congenital heart disease comprises one of the largest groups of congenital defects, affecting approximately 1% of births. Advances in pre- and postoperative critical care treatment as well as surgery and interventional procedures have improved survival rates, but treatment and long-term care of children with complex congenital heart disease remains challenging, and is associated with a number of complications.Here, we report on a 17-month-old infant with congenital univentricular heart disease who devloped post-operatively inferior vena cava (IVC) thrombosis. IVC thrombosis was confirmed by a bedside contrast media study (X-ray) demonstrating collateral paravertebral circulation along the paravertebral sinuses bilaterally into the azygos and hemiazygos vein ("rope ladder sign"), with no contrast media detected in the IVC. The infant was subsequently started on aspirin and clopidogrel.
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