title: Epidural venous enlargements presenting with intractable lower back pain and sciatica in a patient with absence of the infrarenal inferior vena cava and bilateral deep venous thrombosis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To present a rare anomaly of the inferior vena cava associated with radicular pain and to illustrate its imaging characteristics.
  
  
  BACKGROUND
  Irritation of the trigeminal nerve by vascular anomalies, resulting in neuralgia is a well-recognized entity. Recently, compression of peripheral nerve roots due to enlarged epidural venous plexus has been described as a possible cause of back and radicular pain, too.
  
  
  METHODS
  A 26-year-old man presented with acute exacerbation of lower back pain associated with radiculopathy down his left thigh. On radiologic workup, a prolapse of a lumbar intervertebral disc was ruled out, but agenesis of the infrarenal segment of the inferior vena cava was found, which has caused bilateral deep venous thrombosis. Venous flow was redirected mainly via enlarged lumbar epidural, ascending lumbar, and paravertebral veins.
  
  
  RESULTS
  No associated congenital heart or abdominal organ defects were found and screening for thrombophilia was negative. The patient was successfully treated with anticoagulation under which symptoms gradually resolved.
  
  
  CONCLUSIONS
  The authors believe that epidural venous enlargements should be considered as a cause of radicular and/or back pain in patients with anomalies of the inferior vena cava, because pathologic processes compressing nervous structures can cause pain.
authors.affiliation: Department of Radiology, Charité, Campus Buch, Berlin, Germany. oliver.dudeck@charite.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Dudeck
authors.forename: Martin
authors.initials: M
authors.lastname: Zeile
authors.forename: Alexander
authors.initials: A
authors.lastname: Poellinger
authors.forename: Lothar
authors.initials: L
authors.lastname: Kluhs
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Ludwig
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004824:Epidural Space / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007405:Intervertebral Disc Displacement / Q000175:diagnosis; D017116:Low Back Pain / Q000209:etiology*; D008223:Lymphoma / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D009408:Nerve Compression Syndromes / Q000209:etiology*; D012082:Renal Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis; D012585:Sciatica / Q000209:etiology*; D013126:Spinal Nerve Roots; D013924:Thrombophlebitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014648:Varicose Veins / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging