Inferior Vena Cava Thrombosis, Appendicitis Mimic.

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Radiology

Background:

• Right lower quadrant abdominal pain is a common emergency department presentation.
• Appendicitis is the most frequent diagnosis, but other conditions must be considered.
• Inferior vena cava (IVC) thrombosis is a rare but critical differential diagnosis.

Purpose of the Study:

• To report a unique case of IVC thrombosis presenting as acute abdominal pain.
• To emphasize the diagnostic challenges in differentiating IVC thrombosis from appendicitis.
• To highlight the utility of advanced imaging in diagnosing rare vascular abnormalities.

Main Methods:

• Case report of a 20-year-old active duty male with acute abdominal pain.
• Utilized computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis.
• Reviewed clinical presentation, diagnostic work-up, and imaging findings.

Main Results:

• Imaging revealed a bland thrombus within the IVC, attributed to a vascular web.
• The patient's symptoms mimicked classic appendicitis.
• Clinical examination and scoring metrics were insufficient for definitive diagnosis.

Conclusions:

• IVC thrombosis secondary to a vascular web can present atypically with right lower quadrant pain.
• Emergency physicians should consider rare vascular pathologies in the differential diagnosis of abdominal pain.
• Advanced imaging is crucial for diagnosing uncommon causes of abdominal pain and thrombosis.