Case Presentation: A 63-year-old male presented with symptomatic orthostatic hypotension and acute kidney injury (AKI). On the day of hospital admission, the patient visited his neurosurgeon for a follow up appointment and was found to have a blood pressure of 60/40 with a heart rate of 130. The patient had been experiencing lightheadedness with standing, decreased urination, and leg edema for the past month. He was sent to the ER for further evaluation.
His medical history was significant for morbid obesity; he had a gastric sleeve procedure performed 8/2014 with concomitant Inferior Vena Cava (IVC) filter placement. The post-operative course was complicated by poor oral intake requiring TPN; this was further complicated by a spinal abscess requiring surgical excision and IV antibiotics (which were completed 5 days prior to this presentation).
Upon presentation to the ER, the patient’s blood pressure was 100/65, heart rate was 100, temperature was 98.6F, and oxygen saturation was 100% on room air. Standing blood pressure could not be obtained on admission due to the patient’s severe lightheadedness when attempting to stand. Laboratory studies revealed creatinine of 3.38 (baseline of 0.9) with associated hyperkalemia of 6.0. The patient was started on IV fluids due to presumed dehydration. Orthostatic vital signs were checked daily during hospital course; orthostatic vital signs were persistently positive despite adequate fluid resuscitation. After extensive testing, the cause of the patient’s persistent orthostatic hypotension and AKI was determined to be IVC syndrome caused by occlusive deep venous thrombosis (DVT) extending distally from the patient’s IVC filter through both lower extremities. Catheter directed thrombolysis of DVTs was performed via bilateral popliteal catheters. The patient tolerated the procedure well and was given Coumadin until INR was in therapeutic range. His orthostatic hypotension and AKI improved prior to discharge to the rehabilitation facility.
Discussion: IVC syndrome is the result of compression or obstruction of the IVC. This compromise can be caused by tumor, venous thrombosis, abdominal structures (such as the uterus during pregnancy), iatrogenic measures, and Budd-Chiari syndrome. IVC syndrome can be difficult to diagnose due to varied presenting symptoms. Common symptoms that may be seen with compromise of the IVC are symptoms of decreased venous return (leg edema, hypotension, tachycardia).
Conclusions: IVC syndrome can be difficult to diagnose due to presenting symptoms that are not very specific. This patient displayed orthostatic hypotension, which may be a sign of multiple clinical entities and is not specifically associated with IVC syndrome. Patients that present with symptoms of decreased venous return, exhibit appropriate physical exam findings, and possess risk factors for thrombosis should be evaluated for DVT and complicating IVC syndrome.
To cite this abstract:Popplewell CM, Makhnevich A. A Male with Signs of Pregnancy: A Case of Ivc Syndrome. Abstract published at Hospital Medicine 2016, March 6-9, San Diego, Calif. Abstract 738. Journal of Hospital Medicine. 2016; 11 (suppl 1). https://www.shmabstracts.com/abstract/a-male-with-signs-of-pregnancy-a-case-of-ivc-syndrome/. Accessed May 22, 2019.