Korean J Gastroenterol.  2018 Sep;72(3):146-149. 10.4166/kjg.2018.72.3.146.

Deep Vein Thrombosis Due to Compression of Huge Hepatic Cyst Successfully Treated by Inferior Vena Cava Filter and Cyst Drainage

Affiliations
  • 1Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. nyheo@hanmail.net
  • 2Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Abstract

An 88-year-old woman complained of right quadrant abdominal pain and severe edema in both legs. She had a history of pulmonary embolism one month ago. Abdomen CT showed a huge hepatic cyst compressing the intrahepatic portion of the inferior vena cava (IVC). The venogram CT showed multifocal thrombosis in the iliocaval and both lower extremity veins. Percutaneous hepatic cyst drainage was carried out. Fluid analysis presented leukocytosis, which suggested an infected hepatic cyst. To prevent secondary pulmonary thromboembolism, an IVC filter was inserted before catheter drainage for the hepatic cyst. One week later, abdominal pain was relieved. Then, sclerotherapy for the remnant hepatic cyst was performed by ethanol. Follow-up CT showed an increased amount of thrombosis in the iliocaval and left calf vein, but the IVC filter prevented another thromboembolic event successfully. The patient started dabigatran, a new oral anticoagulant, and compression stockings were applied to both legs. After one month, no visible thrombosis in the pelvis or either extremity was detected in abdominal CT. This case suggests that a huge hepatic cyst, especially with infection, should be considered as a possible cause of deep vein thrombosis if no other risk factors for thromboembolism exist.

Keyword

Liver; Cysts; Venous thrombosis; Vena cava filters

MeSH Terms

Abdomen
Abdominal Pain
Aged, 80 and over
Catheters
Dabigatran
Drainage*
Edema
Ethanol
Extremities
Female
Follow-Up Studies
Humans
Leg
Leukocytosis
Liver
Lower Extremity
Pelvis
Pulmonary Embolism
Risk Factors
Sclerotherapy
Stockings, Compression
Thromboembolism
Thrombosis
Tomography, X-Ray Computed
Veins
Vena Cava Filters*
Vena Cava, Inferior*
Venous Thrombosis*
Dabigatran
Ethanol

Figure

  • Fig. 1 Huge hepatic cyst compressing the intrahepatic portion of inferior vena cava was noted.

  • Fig. 2 Venogram extremity computed tomography showed thrombosis in the inferior vena cava below the renal vein (A, white arrow) and both femoral veins (B, white arrows) on the axial scan. A long segment of thrombosis near bifurcation of the inferior vena cava into common iliac veins was detected during the coronal scan (C, black arrows).

  • Fig. 3 Filter was inserted in the inferior vena cava, and filling defect due to thrombosis in the right common iliac vein was detected during venography.

  • Fig. 4 Last follow-up CT at one month after cyst drainage and anticoagulation showed the patent inferior vena cava without thrombus (white arrow) and loss of hepatic cysts. CT, computed tomography.


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