Pediatric Radiology
Pediat. Radiol. 6, 176-177 (1977)
9 by Springer-Verlag1977
Case Reports Congenital Calcified Thrombosis of Inferior Vena Cava, Bilateral Renal Veins and Left Spermatic Vein C. H. Tseng 1, G. K. J. Chang2, and F. Lora2 1 Veterans Administration Center, Dayton, Ohio, and 2 Wilson Memorial Hospital Johnson City, New York, USA
Abstract. An infant with severe congenital calcified thrombosis in the inferior vena cava, bilateral renal veins and left spermatic vein is presented. Five previously published cases and pertinent points concerning this rare occurence are discussed. The etiology of this calcified thrombosis remained unknown.
Key words: Calcified thrombosis - Inferior vena cava - Renal veins Calcified thrombosis of the inferior vena cava in infants is a rare occurrence. [2, 3, 4, 5]. Recently we observed a newborn infant who has extensive calcification, not only in the inferior vena cava, but also in bilateral renal veins and their tributaries and the left spermatic vein.
renal veins and their tributaries, and the left spermatic vein (Fig. 1 and 2). The lumen of the inferior vena cava and of the renal veins was completely occluded by the calcified thrombi. The kidneys were not infarcted and there was no other evidence of thrombosis in other organs.
Comments The previous cases of calcified caval thrombosis [2, 3, 4, 51 included three cases [2, 3, 5] without other anomalies and two [4] with other abnormalities including congenital toxoplasmosis (with jaundice, hepatosplenomegaly and prematurity)
Case Report A white boy was born at term on November 13, 1974 by breech delivery in apparently good condition. Birth weight was 2550 grams. Apgar score was 2 at 1 minute and 4 at 5 minutes. The baby never cried and severe cyanosis with bradycardia and slow grunting respiration was evident immediately after birth. Arterial blood gases demonstrated respiratory and metabolic acidosis with PaO2 40 mmHg, PaCO2 80 mmHg, HCO3 14.9 meq/1 and pH 6.89. In spite of vigorous therapy in the intensive care unit, the patient expired two hours and 23 minutes after birth. At autopsy, the patient was found to have subdural and subarachnoid hemorrhage throughout both hemispheres, more prominent on the surface than at the base. There were extensive calcified thrombi in the inferior vena cava, bilateral
l Associate Professor of Pathology, Wright State University, School of Medicine, Dayton, Ohio, USA 2 The institution from which the work originated
Fig. 1. Gross photograph of calcified vessels
C. H. Tseng et al.: Congenital Calcified Thrombosis
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the inferior vena cava and renal veins. Obviously the process developed in utero. The infant showed no sign of disseminated clotting problems and the histologic findings in the liver, adrenal, lung, spleen and heart failed to show any sign of fetal infection or coagulopathy. The proposed mechanisms offered by Blanc et al. [1] to explain calcified thromboemboli (fetal anemic shock, placento-fetal transfusion, disseminated intravascular clotting) did not seem to play a role in our case. The subdurat and subarachnoid hemorrhage seemed related to the birth process.
References
Fig. 2. Radiophotograph of calcified thrombi of veins in the autopsy specimen
1. Blanc, W. A., Berdon, W. E., Baker, D. H., et al.: Calcified portal vein thromboemboli in newborn and stillborn infants. Radiology 88, 287 (1967) 2. Gammill, S. L., Nice, C. M.: Calcification in the inferior vena cava. Radiology 92, 1288 (1969) 3. Pontd, G., Remy, J., Lacombe, A., et al.: Thrombus calcifi6 de la veine care inferieure avec calcifications rdnales chez un nouveau-nd. Ann. Pddiat. 19, 297 (1972) 4. Singleton, E. B., Rosenberg, H. S.: Intraluminal calcification of the inferior vena cava. Am. J. Roentgenol. Radium Ther. Nucl. Med. 86, 556 (1961) 5. Silvermann, H. R., Borns, P. F., Goldstein, A. H., et al.: Thrombus calcification in the inferior vena cava. Am. J. Roentgenol. Radium Ther. Nucl. Meal. 106, 97 (1969)
Date of final acceptance: August 2, 1977
and a case of hydrocephalus and hepatosplenomegaly in a fullterm girl who died after a ventriculojugular shunt procedure. Our case shows m u c h more extensive and severe calcification with complete occlusion of
C. H. Tseng, M. D., Ph.D. Chief, Laboratory Service Veterans Administration Center Dayton, OH 45428 USA
Pediat. Radiol. 6, 176-177 (1977)
9 by Springer-Verlag1977
Case Reports Congenital Calcified Thrombosis of Inferior Vena Cava, Bilateral Renal Veins and Left Spermatic Vein C. H. Tseng 1, G. K. J. Chang2, and F. Lora2 1 Veterans Administration Center, Dayton, Ohio, and 2 Wilson Memorial Hospital Johnson City, New York, USA
Abstract. An infant with severe congenital calcified thrombosis in the inferior vena cava, bilateral renal veins and left spermatic vein is presented. Five previously published cases and pertinent points concerning this rare occurence are discussed. The etiology of this calcified thrombosis remained unknown.
Key words: Calcified thrombosis - Inferior vena cava - Renal veins Calcified thrombosis of the inferior vena cava in infants is a rare occurrence. [2, 3, 4, 5]. Recently we observed a newborn infant who has extensive calcification, not only in the inferior vena cava, but also in bilateral renal veins and their tributaries and the left spermatic vein.
renal veins and their tributaries, and the left spermatic vein (Fig. 1 and 2). The lumen of the inferior vena cava and of the renal veins was completely occluded by the calcified thrombi. The kidneys were not infarcted and there was no other evidence of thrombosis in other organs.
Comments The previous cases of calcified caval thrombosis [2, 3, 4, 51 included three cases [2, 3, 5] without other anomalies and two [4] with other abnormalities including congenital toxoplasmosis (with jaundice, hepatosplenomegaly and prematurity)
Case Report A white boy was born at term on November 13, 1974 by breech delivery in apparently good condition. Birth weight was 2550 grams. Apgar score was 2 at 1 minute and 4 at 5 minutes. The baby never cried and severe cyanosis with bradycardia and slow grunting respiration was evident immediately after birth. Arterial blood gases demonstrated respiratory and metabolic acidosis with PaO2 40 mmHg, PaCO2 80 mmHg, HCO3 14.9 meq/1 and pH 6.89. In spite of vigorous therapy in the intensive care unit, the patient expired two hours and 23 minutes after birth. At autopsy, the patient was found to have subdural and subarachnoid hemorrhage throughout both hemispheres, more prominent on the surface than at the base. There were extensive calcified thrombi in the inferior vena cava, bilateral
l Associate Professor of Pathology, Wright State University, School of Medicine, Dayton, Ohio, USA 2 The institution from which the work originated
Fig. 1. Gross photograph of calcified vessels
C. H. Tseng et al.: Congenital Calcified Thrombosis
177
the inferior vena cava and renal veins. Obviously the process developed in utero. The infant showed no sign of disseminated clotting problems and the histologic findings in the liver, adrenal, lung, spleen and heart failed to show any sign of fetal infection or coagulopathy. The proposed mechanisms offered by Blanc et al. [1] to explain calcified thromboemboli (fetal anemic shock, placento-fetal transfusion, disseminated intravascular clotting) did not seem to play a role in our case. The subdurat and subarachnoid hemorrhage seemed related to the birth process.
References
Fig. 2. Radiophotograph of calcified thrombi of veins in the autopsy specimen
1. Blanc, W. A., Berdon, W. E., Baker, D. H., et al.: Calcified portal vein thromboemboli in newborn and stillborn infants. Radiology 88, 287 (1967) 2. Gammill, S. L., Nice, C. M.: Calcification in the inferior vena cava. Radiology 92, 1288 (1969) 3. Pontd, G., Remy, J., Lacombe, A., et al.: Thrombus calcifi6 de la veine care inferieure avec calcifications rdnales chez un nouveau-nd. Ann. Pddiat. 19, 297 (1972) 4. Singleton, E. B., Rosenberg, H. S.: Intraluminal calcification of the inferior vena cava. Am. J. Roentgenol. Radium Ther. Nucl. Med. 86, 556 (1961) 5. Silvermann, H. R., Borns, P. F., Goldstein, A. H., et al.: Thrombus calcification in the inferior vena cava. Am. J. Roentgenol. Radium Ther. Nucl. Meal. 106, 97 (1969)
Date of final acceptance: August 2, 1977
and a case of hydrocephalus and hepatosplenomegaly in a fullterm girl who died after a ventriculojugular shunt procedure. Our case shows m u c h more extensive and severe calcification with complete occlusion of
C. H. Tseng, M. D., Ph.D. Chief, Laboratory Service Veterans Administration Center Dayton, OH 45428 USA
