Stenosis of the inferior vena cava caused by a traumatic diaphragmatic hernia: case report

Post-traumatic obstruction of the inferior vena cava (IVC) or hepatic veins is uncommon. Ultrasound examination of a patient with hematuria revealed multiple intrahepatic venous collaterals. MRI showed a herniated right lobe of the liver and a narrowed hepatic segment of the IVC above the level of the patent right hepatic vein insertion. Multiple intrahepatic collaterals around the middle hepatic vein were demonstrated on inferior venacavography. The intrahepatic IVC was angulated and markedly narrowed below the right atrium. Surgical reduction of the herniated right lobe of the liver and repair of the ruptured diaphragm with Teflon felt was performed. On follow-up inferior venacavography, angulation of the IVC was relieved and the intrahepatic collaterals had disappeared. Hematuria subsided after operation.