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Duplicated Inferior Vena Cava Thrombosis Mimicking Acute Pancreatitis in a COVID-19 Patient
Louis Costanzo1, Bhesh R Karki1, Brian Soto1
1Internal Medicine, Downstate-Health Sciences University of New York, Brooklyn, USA.
Insights
Severe COVID-19 can lead to blood clots, including in the inferior vena cava (IVC). Early detection and anticoagulation are crucial for successful treatment of IVC thrombosis in COVID-19 patients.
Area of Science:
- Internal Medicine
- Vascular Surgery
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic events.
- COVID-19-associated coagulopathy can manifest in various forms, including venous thromboembolism.
- Inferior vena cava (IVC) thrombosis is a rare but serious complication.
Abstract:
An 86-year-old woman with a recent hospitalization for severe coronavirus disease 2019 (COVID-19) infection presented to the emergency department with abdominal discomfort and bilateral leg swelling. She was mildly tachycardic on physical exam, with superficial abdominal vessel dilation and bilateral lower extremity edema. Her laboratory results were significant for a mildly elevated lipase of 260 U/L (normal range: 0-160 U/L) and a positive COVID-19 PCR test. CT of the abdomen and pelvis did not show any pancreatic abnormality but revealed a duplicated inferior vena cava (IVC) with a thrombus located in the right IVC. The patient was subsequently placed on full-dose anticoagulation with the eventual achievement of clot lysis. It appears that the incidence of thrombosis, including IVC thrombosis, has been on the rise due to COVID-19-associated coagulopathy; therefore, a high index of clinical suspicion in these cases may prove to be lifesaving.
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