A case is reported of obstruction of the inferior vena cava in a 83 years old male school teacher. The diagnosis was confrimed by femoral venography, which revealed complete obstruction of both the inferior vena cava and the common iliac veins bilaterally.
The patient had a history of intermittent swelling of the lover extremities, venous distension of the lower chest, abdomen, lumbar region, and the lower extremities, and occasional reddish urination for the past two and a half years. Review of history revealed the occurence f dysentery at the age of 16. For the past four years he had noticed slight exertional dyspnea. He had been a heany drinker and had smoked a pack of cigarrettes per day. Family history was noncontributory
The physical examination on admission showed his development to be average and nutrition to be poor, temperature 37.1℃, pulse80/min., respiration 20/min., and blood pressures on the upper and lower extremities were 90/60mm. Hg and 120/80mm.Hg respectively. The positive signs were as follows: brownish discoloration of the skin;spider angiomata on the anterior upper chest wall; a tortuous venous distension with and ascending flow on the lower chest wall, abdomen, lumbar region, anmd the lower extremities; slight pitting edema on the pretibial and ankle regions; and a palpable liver which descended 2 finger´s breadth below the xyphoid process.
Both the Trendelenberg´s test and Perthe´s test were positive. Teh venous pressure at the antecubital vein was 79mm. H₂O.
The abnormal laboratory findings were : leucopenia (2,7000-4,4000/mm³) with slight lymphocytosis (42-52%); a total bilirubin 4.2mg.% with direct bilirubin 0.86mg.%, cholesterol ester 40.5% of the total cholesterol which was 120mg.%, prothrombin time 80%, thymol turbidity 6.9 units, BSP retention 38%/45 min., trichocephalus tricuris ovae on fecal examination, and the serum ammonia level 135㎍%. X-ray examinations showed chest to be normal, esophagus espohageal varices, and upper G-I irritable of both the inferior vena cava and the common iliac veins bilaterally. The dye appeared in the renal calyces during the procedure.
The final diagnosis was obstruction of the inferior vena cava and the common iliac veins bilaterally, probably due to the thrombosis or thrombophlebitis, and cirrhosis of the liver. The patient was dischanrged on 14th hospital day having received the maximum benefit of hospitalization.
|