Post-traumatic giant thrombosis of inferior vena cava induced right-sided blunt traumatic diaphragmatic injury: a case report
Tóm tắt
Inferior vena cava thrombosis is a severe disease as it carries a higher risk of developing pulmonary embolism associated with a high mortality rate. The incidence of inferior vena cava thrombosis is extremely low and is commonly associated with outflow obstruction of the inferior vena cava. The frequency of traumatic diaphragmatic injuries is less than 1% of all traumatic injuries. In addition, it was not a typical cause of inferior vena cava obstruction. We report the case of the patient who presented with giant thrombosis of the inferior vena cava, which required surgical treatment-induced right-sided blunt traumatic diaphragmatic injury. A 60-year-old male presented to the emergency department with pelvic and lower leg pain. He was working on a dump truck with the bed raised position. Suddenly, the bed came down, and his body was crushed and injured. Primary CT showed a right lung contusion and elevation of the right diaphragm but no apparent liver injury. The right pleural effusion gradually worsened after admission, as the traumatic diaphragmatic injury was highly suspected. Repeat CT showed aggravation of elevation of the right-sided diaphragm, narrowing of the inferior hepatic vena cava due to left cephalic deviation of the liver, and formation of a giant thrombus in the inferior vena cava. No adverse hemodynamic effects were observed due to thrombus formation, and we performed thrombolytic therapy. The day after starting thrombolytic therapy, the patient developed pulmonary embolism due to a dropped in SpO2 needed oxygen, and dyspnea triggered by coughing. Thrombolytic therapy was continued after the diagnosis of pulmonary embolism. However, thrombolytic therapy was ineffective, so we decided on surgical thrombectomy and inferior vena cava filter placement. The postoperative course was not eventful, and an anticoagulant was started. The patient was transferred to the hospital on the 62nd day for rehabilitation. When a diaphragmatic hernia is suspected of causing hepatic hernia and narrowing of the inferior vena cava, it may be necessary to consider emergency surgical treatment to prevent secondary inferior vena cava thrombosis and fatal pulmonary embolism.
Tài liệu tham khảo
Shi W, Dowell JD. Etiology and treatment of acute inferior vena cava thrombosis. Thromb Res. 2017;149:9–16.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160(6):809–15.
Fair KA, Gordon NT, Barbosa RR, Rowell SE, Watters JM, Schreiber MA. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg. 2015;209(5):864–8.
Mahamid A, Peleg K, Givon A, Alfici R, Olsha O, Ashkenazi I. Blunt traumatic diaphragmatic injury: a diagnostic enigma with potential surgical pitfalls. Am J Emerg Med. 2017;35(2):214–7.
Chughtai T, Ali S, Sharkey P, Lins M, Rizoli S. Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg. 2009;52(3):177–81.
Rodriguez-Morales G, Rodriguez A, Shatney CH. Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients. J Trauma. 1986;26(5):438–44.
Sala C, Bonaldi M, Mariani P, Tagliabue F, Novellino L. Right post-traumatic diaphragmatic hernia with liver and intestinal dislocation. J Surg Case Rep. 2017;2017(3):rjw220.
Guth AA, Pachter HL, Kim U. Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg. 1995;170(1):5–9.
Teter K, Schrem E, Ranganath N, Adelman M, Berger J, Sussman R, et al. Presentation and management of inferior vena cava thrombosis. Ann Vasc Surg. 2019;56:17–23.
Grmoljez PF, Donovan JF, Willman VL. Traumatic inferior vena caval obstruction. J Trauma. 1976;16(9):746–8.
Mayzlík J, Procházka V, Michalský R, Docekal B. Surgical treatment of post-traumatic thrombosis of the inferior vena cava. Rozhl Chir. 1992;71(1):43–6.
Kimoto T, Kohno H, Uchida M, Yamanoi A, Yamamoto A, Nagasue N, et al. Inferior vena caval thrombosis after traumatic liver injury. HPB Surg. 1998;11(2):111–6.
Balian A, Valla D, Naveau S, Musset D, Coué O, Lemaigre G, et al. Post-traumatic membranous obstruction of the inferior vena cava associated with a hypercoagulable state. J Hepatol. 1998;28(4):723–6.
Cellarier G, Carli P, Laurent P, Bonal J, Thouard H, Dussarat GV. Post-traumatic vena cava thrombosis. Presse Med. 1999;28(29):1575–8.
Fujii H, Ohashi H, Tsutsumi Y, Onaka M. Open heart surgery for posttraumatic inferior vena caval thrombosis. Eur J Cardiothorac Surg. 2002;22(2):319–20.
Ushijima T, Yachi T, Nishida Y. Successful surgical treatment of chronic inferior vena caval thrombosis following blunt trauma. Gen Thorac Cardiovasc Surg. 2007;55(6):255–8.
Hamamoto M, Kobayashi T, Kodama H, Nakamitsu A, Sasaki M, Kuroo Y. Thrombectomy under cardiopulmonary bypass for inferior vena cava thrombosis induced by liver injury. Ann Vasc Dis. 2013;6(4):751–5.
Sabzi F, Karim H, Haghi M. Supra hepatic inferior vena cava and right atrial thrombosis following a traffic car crash. J Inj Violence Res. 2016;8(2):111–3.
Salloum C, Lim C, Hillion ML, Azoulay D. Reconstruction of the inferior vena cava due to blunt hepatic trauma. J Visc Surg. 2016;153(1):75–6.
Alkhouli M, Morad M, Narins CR, Raza F, Bashir R. Inferior vena cava thrombosis. JACC Cardiovasc Interv. 2016;9(7):629–43.
McDonald AA, Robinson BRH, Alarcon L, Bosarge PL, Dorion H, Haut ER, et al. Evaluation and management of traumatic diaphragmatic injuries: a Practice Management Guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2018;85(1):198–207.
Kesavaramanujam S, Morell MC, Harigovind D, Bhimmanapalli C, Cassaro S. Total thoracic herniation of the liver: a case of delayed right-sided diaphragmatic hernia after blunt trauma. Surg Case Rep. 2020;6(1):178.