THROMBOLYSIS OF AN EXTENSIVE DEEP VENOUS THROMBOSIS OF THE LOWER-BODYBECAUSE OF INFERIOR VENA-CAVA ANOMALY

History and clinical findings: A 41-year-old man was admitted to hospi tal for acute pain in the right flank. At first urolithiasis was suspe cted but excluded by sonography and excretion urography. Computed tomo graphy (CT) was performed because of increasing pain and swelling of t he left leg. It showed bilateral thrombosis of the deep leg and pelvic veins as well as of the infrarenal inferior vena cava (IVC) and the r ight renal vein. The patient's general condition was impaired. The cir cumference of the left leg was greater than that of the right by 5 cm 15 cm above the knee joint space and both legs had marked varicosities with congestive dermatitis. Investigation 5: The concentration of the thrombin-antithrombin complex was 13.4 mu g/l, D-dimer 124 mu g/l, pr othrombin fragment F-1+2 3,5 nmol/l and fibrin monomere 27.7 mu g/ml, as expression of a manifest thrombosis. CT with contrast medium demons trated the previously sonographically shown extent of the thrombosis. In addition the hepatic IVC segment was absent. The azygos vein was en larged and there was an extensive collateral circulation. Treatment an d course: Systemic thrombolysis (streptokinase for 3 days, then urokin ase) for 11 days dissolved the thrombi and CT now demonstrated complet e recanalization of the caudal deep vein system and the IVC abnormalit y (absence of hepatic segment). After intravenous thrombolysis oral an ticoagulation with phenprocoumon was started and will be continued all the patient's life.