1. Case Presentation Kannur Clinical Club Mahroof T MBBS 2006

2. Name: Mr. Kunhikannan, Age: 65 yrsSex: male, Address: Maloor Occupation: painter

25. -video-

28. Venacavogram: Total obstruction of Inferior Vena Cava in the intrahepatic portion with azygos continuation

29. Diagnosis

30. IVC Obstruction  William Osler in 1879  Obstruction: SVC > IVC  Severity & pattern of symptoms  obstruction above the renal veins  recurrent pulmonary emboli

31. Anatomy of Inferior Vena Cava Left & Right common iliac veins Right Gonadal vein Left Gonadal vein Right & Left Renal veins Hepatic veins Right suprarenal vein Left suprarenal vein Lumbar veins

32. IVC Obstruction Chronic Obstruction Collaterals engorge to bypass blood If collaterals superficial, visible over skin

33. IVC Obstruction Superficial inf. epigastric veinsAnastomose Superior, superficial & deep epigastric venous system Internal thoracic veinsBrachiocephalic veins Superior vena cava Collaterals

34. IVC Obstruction  Pt. breathless  fluid overload and oedema  If hepatic vein occlusion ascites

35. IVC Obstruction  C auses of obstruction of the inferior vena cava  Neoplasia  Thrombosis  Liver or pancreatic disease  Lymphadenopoathy  Adhesions  Aortic aneurysm  Congenital  Embolism  Iatrogenic

36. Treatment  Surgery  percutaneous interventions

37. Thank you

38. Ref:  Harrison’s Medicine  Kundu’s Medicine  Das Surgery  Bailey & Love Surgery  emedicine.com  Gray’s Anatomy Thanks to: Dr. Raveendran P, Cheif Cardiologist – KMC Dr. Sujith O Head of Dept of Neurology – KMC Mr. Kunhikannan, Patient -KMCH

39. Mahroof Thamarassery MBBS 2006 Kannur Medical College me@tmahroof.com http://tmahroof.com