Bicaval Thrombosis and Systemic-to-Pulmonary Venous Shunting: A Case Report and Systematic Review of the Literature.

Abstract

Systemic-to-pulmonary venous shunts (SPVSs) in the setting of combined superior and inferior venae cavae occlusion are exceedingly rare. A 52-year-old female with antiphospholipid syndrome and venous thromboembolism (on Coumadin) was admitted with shortness of breath and profound hypoxia. She had a retained fractured dialysis catheter from the superior to inferior vena cava. Imaging showed thrombotic bicaval occlusion, with extensive collateralization from peri-hepatic and chest wall veins to the right pulmonary veins. Due to poor neurological status due to hypoxic brain injury and refractory hypoxemia, family opted to pursue comfort care. A comprehensive literature search yielded 29 additional cases of SPVSs, with a male majority (53%) and mean age of 43.5 years. Only 7 cases (∼23%) reported bicaval obstruction, all occurring during or after the year 2000. We highlight SPVSs as a possible cause of refractory hypoxia. Early intervention to relieve central obstruction and exclude SPVSs is the cornerstone of management.