Endovascular treatment of an obstructive membrane between inferior vena cava and right atrium in an unrecognized Budd-Chiari syndrome

Background Budd-Chiari syndrome is defined as a hepatic venous outflow track obstruction of various etiology, which appears at different levels. The inferior vena cava outflow membrane is an unusual, but a potentially treatable cause. The percutaneous treatment has emerged as a very promising management mode for such patients. Follow-up results are favorable for balloon angioplasty and/or stenting, with minimal re-stenosis rates. Case presentation We report a case of a young woman, earlier operated on congenital heart defect and with previous pulmonary embolic incident after childbirth, with no evidence of thrombophilia. She was admitted to our institution for a suspected right atrial tumor. After the diagnosis of Budd-Chiari syndrome caused by membranous inferior vena cava obstruction, a percutaneous treatment of a thick membrane was successfully performed, using an unusual technique. Conclusion Balloon angioplasty should be considered in cases of membranous obstruction of vena cava, where a focal obstruction is causing the symptoms. In our patient, the anatomy was not suitable for stenting, and balloon dilatation was successful just after the membrane was pulled apart with a big balloon in a “Rashkind-like” procedure.

Complete Superior and Inferior Vena Cava Obstruction Associated with Systemic-to-Pulmonary Venous Shunts in a Young Female with Heterozygous Prothrombin G20210A Gene Mutation

Complete superior vena cava (SVC) and inferior vena cava (IVC) obstruction is not uncommon and most commonly associated with malignancy. The risk increases in patients with central lines and hypercoagulable states such as with malignancy, thrombophilia, or use of oral contraceptive pills. According to our knowledge, complete SVC and IVC obstruction associated with systemic-to-pulmonary venous shunts in patients with prothrombin G20210A gene mutation has not been reported in the literature. Here we report the case of a 34-year-old female with complete SVC and IVC obstruction presenting with oxygen desaturation and shortness of breath due to systemic-to-pulmonary venous shunts. The unusual collateral pathway was secondary to SVC obstruction. The patient was managed conservatively, and she remained stable.

SONOGRAPHIC EVALUATION OF OUTFLOW VEINS IN SUDANESE LIVER TRANSPLANTS

The purpose of this study was to identify the specific Doppler criteria for the outflow vein (hepatic veins and inferior vena cava) obstruction in liver transplants. A case control study was done after performing venous Doppler sonographic studies in 300 normal (control) and 45 liver transplant cases (4 whole liver, 41 lobar) with no vascular obstruction. The ultrasonic Doppler study were classified as normal, occluded, or stenosed on the basis of gray scale and color flow mapping appearances as well as elevated or absent waves. The following Doppler parameters were evaluated: the outflow veins on color Doppler interrogation, venous pulsatility index on spectral trace. Receiver operating characteristic curves were constructed. There were no cases of outflow vein obstruction found in our sample (neither stenosis, nor occlusion). Mean venous pulsatility index for normal outflow veins was 0.75 and is found ranging between (0.55-0.75). A venous pulsatility index of < 0.45 is specific for stenosis (5). The venous pulsatility index is a useful parameter for diagnosing venous stenosis in liver transplants.

A novel etiology for craniospinal hypovolemia: a case of inferior vena cava obstruction

The authors report on a patient with craniospinal hypovolemia and inferior vena cava obstruction, and describe how the two conditions may be linked. This unique report further advances the emerging literature on spinal CSF venous fistulae.