Volume 151, Issue 2, Pages e35-e39 (February 2017)

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Volume 151, Issue 2, Pages e35-e39 (February 2017) A 27-Year-Old Man With Acute Severe Low Back Pain and Bilateral Leg Swelling That Prompted Renting a Wheelchair for Mobility John G. Williams, MD, Huy Phan, BS, Helena R. Winston, MD, Randolph V. Fugit, PharmD, Bridget Graney, MD, Brant Jamroz, MD, Benjamin English, MD, Edward D. Chan, MD CHEST Volume 151, Issue 2, Pages e35-e39 (February 2017) DOI: 10.1016/j.chest.2016.08.1459 Copyright © 2016 Terms and Conditions

Figure 1 Abdominal CT scan. Sagittal CT image showing the narrowed suprarenal inferior vena cava (IVC) (small arrow), dilated nonopacified distal IVC (asterisk), and dilated venous collaterals (large arrow). CHEST 2017 151, e35-e39DOI: (10.1016/j.chest.2016.08.1459) Copyright © 2016 Terms and Conditions

Figure 2 Venograms of the lower extremity veins showing progressive resolution of the DVT with catheter-directed thrombolytic infusion (all venograms are posterior views taken with the patient in the prone position). A, Complete thrombosis of the left iliac vein with no significant venous outflow after 21 hours of catheter-directed thrombolysis (arrow). B, Complete thrombosis of the right iliac vein with no significant venous outflow after 21 hours of catheter-directed thrombolysis. C, The ascending lumbar collaterals are the only patent pelvic outflow veins, as the common iliac venous confluence and IVC remain thrombosed after 52 hours of catheter-directed thrombolysis. D, Bilateral iliac veins showing marked reduction in clot burden after mechanical thrombolysis was performed in addition to the ongoing infusion of tissue plasminogen activator (tPA) at about 52 hours. E, Bilateral iliac veins showing marked reduction in clot burden at 74 hours of catheter-directed thrombolysis. Note the large left ascending lumbar collateral (arrow) arising before confluence of the iliac veins. F, Bilateral superficial femoral veins now nearly free of thrombus after 74 hours of ongoing catheter-directed thrombolysis. CHEST 2017 151, e35-e39DOI: (10.1016/j.chest.2016.08.1459) Copyright © 2016 Terms and Conditions