Presentation
Abdominal discomfort, recent diagnosis of COVID.
Patient Data
Relative expansion and absent filling of the infrarenal inferior vena cava and bilateral common and external iliac veins, with some mixing of contrast in the distal left external iliac veins but minimal to absent filling on the right. There is associated relative haziness surrounding the veins, as well as a enlarged lumbar collateral that is also be thrombosed on the left. The IVC at and above the level of the renal veins appears to be filling appropriately as well as the intrahepatic segment. No other acute pathology in the abdomen or pelvis. Coronal reformats help confirm the diagnosis.
Case Discussion
Acute thrombosis of the infrarenal inferior vena cava and bilateral iliac veins, with some associated surrounding stranding and enlarged and thrombosed collateral lumbar veins. A finding like this can be easy to overlook unless detailed vascular evaluation is part of your search pattern, and thus this case helps to reinforce the importance of a systematic checklist approach to interpreting abdominopelvic CT. The stranding and mild enlarged lymph nodes surrounding the IVC can help to draw attention to the thrombosis, which otherwise could be also confused with mixing artifact. The coronal reformats also help. This was felt to be related to a hypercoagulable state, potentially contributed by the recent diagnosis of COVID.
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