IVC thrombosis is often under-recognized. Malignancy can cause spontaneous IVC thrombosis due to its prothrombotic potential. Malignant tumors can compress, adhere or infiltrate the IVC wall causing endothelial damage with subsequent thrombosis. Retroperitoneal lymphadenopathy can cause compressive distortion of IVC causing venous stasis and turbulent flow. Metastatic retroperitoneal lymphadenopathy from testicular tumor is a rare cause of IVC invasion with resultant IVC thrombosis which can rarely present as backache. High index of suspicion is needed to detect primary testicular tumor in cases of IVC thrombosis, especially in young individuals.
A 26 -year old male presented with lower back ache, weight loss and fever. MRI Lumbosacral spine done outside showed a soft tissue signal intensity retroperitoneal mass in aortocaval region compressing IVC. Ultrasound (done outside) revealed mild right sided hydroureteronephrosis secondary to a lobulated heterogeneous mass in inter-aortocaval region encasing right ureter and invading IVC causing thrombosis. Contrast enhanced Computerized axial tomography of abdomen showed a heterogeneously enhancing lobulated mass with multiple internal calcifications, in inter-aortocaval region at L3-4 level invading the IVC causing IVC thrombosis. Both tumor thrombus and bland thrombus were present. The right testis showed a subtle 10x10 mm hypodense lesion with peripheral calcification. DW-MRI showed diffusion restriction in retroperitoneal mass and the IVC tumor thrombus. Possibility of primary testicular tumor with metastatic retroperitoneal lymphadenopathy causing IVC invasion with resultant thrombosis was considered which was confirmed on histopathology examination.
McAree BJ, O’donnell ME, Fitzmaurice GJ, Reid JA, Spence RA, Lee B. Inferior vena cava thrombosis: a review of current practice. Vascular Medicine. 2013 Feb;18(1):32-43.
Osman NM, Samy LA. Benign and malignant portal venous thrombosis: Multi-modality imaging evaluation. The Egyptian Journal of Radiology and Nuclear Medicine. 2016 Jun 1;47(2):387-97.
Molina M, Schiappacasse G, Labra A. Tumors that invade the inferior vena cava: an illustrative review of the main imaging features on computed tomography and magnetic resonance. Rev ChilRadiol. 2016;22:39-46.
Dusaud M, Bayoud Y, Desfemmes FR, Molimard B, Durand X. Unusual presentation of testicular cancer with tumor thrombus extending to the inferior vena cava. Case reports in urology. 2015;2015.
Bredael JJ, Vugrin D, Whitmore Jr WF. Autopsy findings in 154 patients with germ cell tumors of the testis.Cancer. 1982 Aug 1;50(3):548-51.
Johnson DE, Appelt G, Samuels ML, Luna M. Metastases from testicular carcinoma study of 78 autopsied cases. Urology. 1976 Sep 1;8(3):234-9.
Husband JE, Bellamy EA. Unusual thoracoabdominal sites of metastases in testicular tumors. American Journal of Roentgenology. 1985 Dec 1;145(6):1165-71.
Burnand KG, Irvine AT, Wilson NM. Deep vein thrombosis: pathology. InDisease of the veins 1999 (pp. 249-289).Arnold London.
Ng CS, Husband JE, Padhani AR, Long MA, Horwich A, Hendry WF, Dearnaley DP. Evaluation by magnetic resonance imaging of the inferior vena cava in patients with non‐seminomatous germ cell tumours of the testis metastatic to the retroperitoneum.British journal of urology. 1997 Jun;79(6):942-51.
Lai P, Bomanji JB, Mahmood S, Nagabhushan N, Syed R, Gacinovic S, Lee SM, Ell PJ. Detection of tumour thrombus by 18F-FDG-PET/CT imaging.European journal of cancer prevention. 2007 Feb 1;16(1):90-4.
Agarwal S, Yadav RN, Garg G, Kumar M. Renal cell carcinoma with level 2 IVC thrombus. BMJ case reports. 2018 Jul 5;2018:bcr-2018.
Constantinides C, Recker F, Bruehlmann W, Von Schulthess G, Goebel N, Zollikofer C, Jaeger P, Hauri D. Accuracy of magnetic resonance imaging compared to computerized tomography and renal selective angiography in preoperatively staging renal cell carcinoma. Urologiainternationalis. 1991;47(4):181-5.
Konety BR. Multidetector computed tomography vs magnetic resonance imaging for defining the upper limit of tumour thrombus in renal cell carcinoma: A study and review: Lawrentschuk N, Gani J, Riordan R, Esler S, Bolton DM, Surgery and Urology, University of Melbourne, Austin Hospital, Heidelberg, Victoria, Australia. InUrologic Oncology: Seminars and Original Investigations 2006 Jan 1 (Vol. 24, No. 1, pp. 84-85). Elsevier.
Raup VT, Johnson MH, Weese JR, Hagemann IS, Marshall SD, Brandes SB. Seminoma presenting as renal mass, inferior vena caval thrombus, and regressed testicular mass. Case reports in urology. 2015;2015.
Savarese DM, Rohrer MJ, Pezzella AT, Davidoff A, Fraire AE, Menon M. Successful management of intracardiac extension of tumor thrombus in a patient with advanced nonseminomatous germ cell testicular cancer. Urology. 1995 Dec 1;46(6):883-7.
Geffen DB, Kaneti J, Hendler N, Hertzanu Y. Testicular carcinoma with inferior vena cava thrombosis extending into the right atrium treated with chemotherapy and anticoagulation. European urology. 1992;21:82-4.
Fidias P, Fan CM, McGovern FJ, Wright CD, Kaufman J, Grossbard ML. Intracaval extension of germ cell carcinoma: diagnosis via endovascular biopsy and a review of the literature. European urology. 1997;31:376-9.
Badawi JK, Kittner T, Manseck A, Wirth MW. Intraluminal tumour thrombus of a mixed non-seminomatous germ cell tumour of testis within the inferior vena cava.Oncology Research and Treatment. 2005;28(2):98-100.
Kinebuchi Y, Ogawa T, Kato H, Igawa Y, Nishizawa O, Miyagawa SI. Testicular cancer with tumor thrombus extending to the inferior vena cava successfully removed using veno‐venous bypass: A case report. International journal of urology. 2007 May;14(5):458-60.
Ucer O, Nese N, Muezzinoglu T. Pure Yolk sac presenting with inferior vena cava thrombus extending from bilateral external iliac veins to hepatic vein. International braz j urol. 2016 Dec;42(6):1244-7.
Sun C, Zhou J, Zhao W. Mixed germ cell testicular tumour complicated with inferior vena cava tumour thrombus: A case report and review of the literature. Biomedical Research. 2017 Jan 15;28(1).
Shukla A, Chowdhury D, Mahendru V. Embryonal carcinoma testis with extensive metastasis and IVC thrombosis.Indian J PatholMicrobiol 2019;62:350-2.
This work is licensed under a Creative Commons Attribution 4.0 International License.