PO17 - Rare case presentation of inferior vena cava thrombosis caused with left-sided adrenal carcinoma

Background: : Inferior vena cava thrombosis (IVCT) is a disease associated with high morbidity and rare condition. Most commonly, pulmonary emboli are thought to arise from a lower extremity deep venous thrombosis or IVCT. Most patients with cancer-associated venous thromboembolism are treated with anticoagulation unless there is active bleeding or a high risk of bleeding.

Aims: Here we presented a rare case of cancer associated thrombosis in inferior vena cava

Methods: Case report

Results: An 64-year-old woman with a past history of hypertension, thyroid nodules, HCV (treated in 2014 and controlled by physicians), stomach cancer (which were treated with total gastrectomy and 6 times of chemotherapy in 2014 successively) and varicose veins of lower extremities (which were diagnosed in 2023) was presented in our hospital with complaints of headache, fatigue, tiredness, loss of appetite, fever, mild dyspnea, pain and swelling in both legs. In family history, her mother has cervical cancer and sister were diagnosed with renal cell carcinoma. Laboratory tests revealed macrocytic hyperchromic mild anemia, erythrocytopenia (RBC 2.96 10*12/L, HGB 10.8 g/dL, MCV 107.8 fL, MCH 36.5 pg), c-reactive protein was elevated at 16.88 mg/L and D-dimer was elevated at 2.84 mg/L. An abdominal ultrasound showed 12cm long segmented thrombus of IVC and extending into the left renal vein. Patient underwent contrasted computed tomography (CT) of the abdomen to screen for possible causes of IVCT which revealed a long large mass (13.4 x 3.1 cm) within the intrahepatic portion of the inferior vena cava which appears to extend to left renal vein and incomplete thrombosis in distal part of right renal vein, to investigate for suspecting cancer

Conclusion(s): Anticoagulation with low molecular weight heparin and subsequent warfarin prevents the propagation of thrombus, and catheter-directive thrombolysis is also used.