What are the signs and symptoms of inferior vena cava thrombosis (IVCT)?

Updated: Jun 12, 2018
  • Author: Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, KHS, KCOEG; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Patients with inferior vena caval (IVC) thrombosis (IVCT) may present with a spectrum of signs and symptoms. Patients may be asymptomatic, or they may present only after complications occur.

This variability is a significant part of the challenge of diagnosis. Using a classification system may help the clinician make the correct diagnosis. Thus, patients may present with symptoms that are predominantly thrombotic in origin or predominantly embolic in nature. Additionally, the thrombotic findings are dependent on the degree of occlusion of the IVC and on the location between the iliac confluence and the right atrium.

Patients who have IVCT may present only after having pulmonary embolism (PE). The lack of uniform symptoms and the significant number of asymptomatic patients contribute to this feature of IVCT. In one retrospective review of all patients who had cavography to document IVC thrombus, 20% had angiographically proven PE with no symptoms of deep vein thrombosis (DVT). Thus, PE may be the first sign of IVCT.

In patients with complete absence of the IVC, symptoms associated with severe venous hypertension (eg, bilateral lower-extremity edema, varicose veins, nonhealing venous ulcers, caput medusae, or other manifestations of collateral venous system hypertension/dilatation) may be varied in their manifestation and, in some cases, may not be apparent until later in life.

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