Absent Inferior Vena Cava Resulting in Exercise-Induced Epidural Venous Plexus Congestion and Lower Extremity Numbness

Abstract

This case demonstrates the breadth of anatomic and physiologic understanding a clinician must draw on when approaching patients with nerve root compression symptoms. It is also pertinent to consider performing a hypercoagulable work-up in patients with vascular deformations, as this may prevent future thrombosis.

Congenital anomaly of the inferior vena cava and factor V Leiden mutation predisposing to deep vein thrombosis

“…Epidural vein enlargement due to IVC anomalies is a rare but well-documented pathological process that can result in nerve root compression syndrome 18–21. It is likely that our patient also experienced some degree of nerve compression or irritation due to epidural vein expansion.…”

Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review

“…There are only 20 previously reported cases of myelopathy associated with EVPE secondary to IVC thrombosis, only five of which exhibited symptoms of CES [ Table 1 ]. [ 1 2 4 5 7 8 9 10 12 13 ] Anticoagulation, pharmacomechanical thrombectomy, and IVC stenting were the treatment of choice in many of these cases. Here, following a decompressive laminectomy to rule out an epidural abscess and resect the anteriorly massive dilated L5-S1 venous plexus, the patient's symptoms resolved.…”

Epidural Venous Plexus Engorgement: What Lies Beneath?

“…Epidural venous engorgement may be seen in blocked venous system due to various pathologies such as portal hypertension, Budd-Chiari syndrome, intracranial hypotension, superior or inferior vena cava thrombosis, and abdominal malignancy or in a physiologic state such as pregnancy. It may be asymptomatic, or in case of nerve root compression, there may be radicular symptoms [ 3 , 4 ]. The symptoms may not be due to direct nerve root compression from distended veins.…”

“…Normally developed inferior vena cava is formed by anastomosis of several embryological segments. Absence of suprarenal segment results in continuation of venous flow into the azygos system Congenital aplasia of the infrarenal segment of IVC itself is extremely rare [ 4 , 7 ]. Even though it may be asymptomatic, it is also one of the causes of deep vein thrombosis especially in young patients, so incidentally caught cases should be cautioned for thrombosis.…”

“…Generally published cases are presented with findings of thrombosis, and inferior vena cava agenesis without thrombosis is reported in an article by Kamerath and Morgan which became symptomatic during exercise [ 4 ]. Our patient also did not have any finding of thrombosis.…”