History and admission findings: A 24-year-old patient presented with nonspecific epigastric pain, general feebleness and weakness of both legs. The cardiopulmonary investigations were unremarkable. The abdomen was soft, without muscular resistance or local pressure tenderness. Both legs were moderately swollen without other findings.
Investigations: The laboratory tests showed an elevated D-dimer and fibrinogen, as well as a heterozygous factor V Leiden mutation. Both duplex ultrasonography and computed tomography revealed thrombosis of the distal inferior vena cava (IVC) and both iliac and femoral veins. A short segment of the IVC between the left renal and intrahepatic veins was a-genetic.
Diagnosis, treatment and course: Anticoagulation treatment with phenprocoumon was started for the deep vein thrombosis. At the one-year follow-up no thrombosis of the vena cava and the iliac and femoral veins was detected.
Conclusion: Thrombosis of the IVC in combination with a pelvic vein thrombosis is a rare condition in young patients. If this venous abnormality is found, thrombophilia should be considered in the differential diagnosis. Anticoagulation is the treatment of choice.