A case of inferior vena cava thrombosis caused by compression due to growing giant liver cyst
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Abstract
We report a case of inferior vena cava (IVC) thrombosis caused by compression by a giant liver cyst. A 68-year-old man with a 1-day history of abdominal pain was referred to another hospital. Ultrasonography (US) and enhanced computed tomography (CT) showed a multilobular cyst on the right liver lobe that had increased to 300 mm in diameter from 90 mm 18 months earlier. Thrombosis was detected in the IVC, which was compressed by the cyst. Percutaneous transhepatic cyst drainage achieved no significant change in size. Cytological analysis from the percutaneous drainage tube fluid showed no evidence of malignancy. He was referred to our hospital for further assessment and treatment. Enhanced US using perfluorobutane, CT, and magnetic resonance imaging showed no tumorous lesions in the cyst. Thus, we diagnosed it as a multilobular cyst with no evidence of malignancy. A 3-week course of heparin resulted in the successful resolution of the thrombosis. Cystectomy was subsequently performed and pathological examination showed a multifocal cyst consisting of central suppurative inflammatory exudation and hemorrhagic material, with no malignancy. This case demonstrates that giant, expanding, non-tumorous cysts can cause IVC thrombosis. Careful treatment using heparin successfully resolved the thrombosis and allowed successful cystectomy.
Keywords
Inferior vena cava Thrombosis Hepatic cyst AnticoagulationNotes
Compliance with ethical standards
Conflict of interest
Naruhiro Kimura, Atsunori Tsuchiya, Masahiro Ogawa, Yusuke Watanabe1 Kazunao Hayashi, Junji Yokoyama, Hajime Umezu, and Shuji Terai declare that they have no conflict of interest.
Human rights
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all patients for being included in the study.
References
- 1.Carrim ZI, Murchison JT. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin Radiol. 2003;58:626–9.CrossRefGoogle Scholar
- 2.Torres VE, Rastogi S, King BF, et al. Hepatic venous outflow obstruction in autosomal dominant polycystic kidney disease. J Am Soc Nephrol. 1994;5:1186–92.Google Scholar
- 3.Kelly K, Weber SM. Cystic diseases of the liver and bile ducts. J Gastrointest Surg. 2014;18:627–34.CrossRefGoogle Scholar
- 4.England RA, Wells IP, Gutteridge CM. Benign external compression of the inferior vena cava associated with thrombus formation. Br J Radiol. 2005;78:553–7.CrossRefGoogle Scholar
- 5.Liang P, Cao B, Wang Y, et al. Differential diagnosis of hepatic cystic lesions with gray-scale and color Doppler sonography. J Clin Ultrasound. 2005;33:100–5.CrossRefGoogle Scholar
- 6.Tominaga K, Kamimura K, Sakamaki A, et al. Intraductal papillary neoplasm of the bile duct: a rare liver tumor complicated by malignancy. Hepatology. 2017;66:1695–7.CrossRefGoogle Scholar
- 7.Fong ZV, Wolf AM, Doria C, et al. Hemorrhagic hepatic cyst: report of a case and review of the literature with emphasis on clinical approach and management. J Gastrointest Surg. 2012;16:1782–9.CrossRefGoogle Scholar
- 8.Kitajima Y, Okayama Y, Hirai M, et al. Intracystic hemorrhage of a simple liver cyst mimicking a biliary cystadenocarcinoma. J Gastroenterol. 2003;38:190–3.CrossRefGoogle Scholar
- 9.Alkhouli M, Morad M, Narins CR, et al. Inferior vena cava thrombosis. JACC Cardiovasc Interv. 2016;9:629–43.CrossRefGoogle Scholar
- 10.Syal G, Klair JS, Aduli F. Leg swelling and mildly deranged liver tests: an unusual presentation of a usual diagnosis. Gastroenterology. 2015;149:e10–1.CrossRefGoogle Scholar