[Thrombolysis of an extensive venous thrombosis of the lower body in an anomaly of the vena cava inferior].
METHODS
A 41-year-old man was admitted to hospital for acute pain in the right flank. At first urolithiasis was suspected but excluded by sonography and excretion urography. Computed tomography (CT) was performed because of increasing pain and swelling of the left leg. It showed bilateral thrombosis of the deep leg and pelvic veins as well as of the infrarenal inferior vena cava (IVC) and the right renal vein. The patient's general condition was impaired. The circumference of the left leg was greater than that of the right by 5 cm 15 cm above the knee joint space and both legs had marked varicosities with congestive dermatitis.


METHODS
The concentration of the thrombin-antithrombin complex was 13.4 micrograms/l, D-dimer 124 micrograms/l, prothrombin fragment F1+2 3,5 nmol/l and fibrin monomere 27.7 micrograms/ml, as expression of a manifest thrombosis. CT with contrast medium demonstrated the previously sonographically shown extent of the thrombosis. In addition the hepatic IVC segment was absent. The azygos vein was enlarged and there was an extensive collateral circulation.


METHODS
Systemic thrombolysis (streptokinase for 3 days, then urokinase) for 11 days dissolved the thrombi and CT now demonstrated complete recanalization of the caudal deep vein system and the IVC abnormality (absence of hepatic segment). After intravenous thrombolysis oral anticoagulation with phenprocoumon was started and will be continued all the patient's life.
Rühlmann
C
C
Medizinische Klinik und Poliklinik I, Universität Leipzig.
Engelmann
L
L
Scheel
H
H
Siegemund
A
A
Biesold
M
M
D000328:Adult; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D013924:Thrombophlebitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014682:Vena Cava, Inferior / Q000002:abnormalities*
D005343:Fibrinolytic Agents; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator
Thrombolyse einer ausgedehnten Venenthrombose der unteren Körperhälfte bei Anomalie der Vena cava inferior.