Acute pelvic congestion in caval atresia due to mesenteric vein thrombosis after SARS-CoV-2 infection

Introduction

COVID-19, caused by SARS-CoV-2, has led to approximately 777 million cases and 7 million deaths globally, primarily due to respiratory failure, and continues to account for thousands of deaths each month [1].

In addition to respiratory symptoms, venous thrombosis is a well-recognized complication of COVID-19, often occurring during the disease course [2]. In the context of COVID-19, it is thought to result from hypercoagulability triggered by the infection, which can lead to severe thrombotic complications even in young, otherwise healthy individuals. The risk of thrombosis is particularly concerning when compounded by underlying vascular anomalies.

Congenital atresia of the inferior vena cava (IVC) is a rare condition that accounts for approximately 5% of deep vein thrombosis (DVT) cases in young patients without other risk factors [3]. The IVC comprises three segments with distinct embryonic origins: the suprahepatic, the suprarenal, and the infrarenal IVC. While congenital defects in the suprarenal IVC with azygos continuation occur in about 0.6% of the population, the absence of the infrarenal IVC is much rarer and is thought to arise from thrombosis during fetal development rather than genetic causes [4].

This case report describes a 38-year-old man who developed severe thrombotic complications two weeks after a mild SARS-CoV-2 infection, including compartment syndrome, pulmonary embolism, and mesenteric ischemia. Imaging revealed IVC atresia with collateral drainage. This highlights the importance of recognizing asymptomatic vascular anomalies that can worsen thrombotic complications in COVID-19.

Publication History

Received: 16 December 2024

Accepted after revision: 13 May 2025

Article published online:
17 June 2025

• References

• 1 WHO. https://covid19.who.int
• 2 Tan BK, Mainbourg S, Friggeri A. et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax 2021; 76: 970-979
• 3 Chee YL, Culligan DJ, Watson HG. Inferior vena cava malformation as a risk factor for deep venous thrombosis in the young. Br J Haematol 2001; 114: 878-880
• 4 Ghandour A, Partovi S, Karuppasamy K. et al. Congenital anomalies of the IVC—embryological perspective and clinical relevance. Cardiovasc Diagn Ther 2016; 6: 482-492
• 5 Prokop M, van Everdingen W, van Rees Vellinga T. et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology 2020; 296: E97-E104
• 6 Acosta S, Salim S. Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies. Scand J Surg 2021; 110: 123-129