IS Case 592: Thrombus formation in the IVC from hypercoagulable state leading to pulmonary embolism

Narasimhachar G. Prativadi, MD

Imaging Sciences URMC

Imaging Sciences URMC 2010
Publication Date: 2011-11-17

History

Patient is a 73-year-old female with history of renal cell cancer and nephrectomy who presented as an outpatient for evaluation of progression of metastatic disease.

Findings

CT images of the abdomen revealed a large inferior vena cava (IVC) thrombus. Chest CT images revealed a right middle lobe segmental pulmonary embolism (PE) with a peripheral wedge shaped lung infarction.

Diagnosis

Thrombus formation in the IVC from hypercoagulable state leading to pulmonary embolism

Discussion

This is an excellent example of how a hypercoagulable state such as malignancy can lead to thrombus formation in the venous circulation and then to pulmonary embolism as small thrombi are taken off of the main thrombus due to flow and carried into the pulmonary vasculature. Other risk factors for pulmonary embolism include postoperative patient, trauma and burn, prior history for PE or DVT, immobility, obesity, CHF, neurologic event, hormonal events, coagulopathies.

References

  1. Helms C, Brant W. Fundamentals of Diagnostic Radiology. Philadelphia, PA: Lippincott Williams & Wilkins, 2007.
  2. Weissleder R, Wittenberg J, Harisinghani MG. Primer of Diagnostic Imaging. Philadelphia, PA: Mosby Elsevier, 2007.

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