Large Inferior Vena Cava Aneurysm, a Case of Associated Pulmonary Emboli in a Healthy Vicenarian Male

Introduction, Objectives, and/or Purpose: Aneurysms of the Inferior vena cava (IVC) are a subset of venous aneurysms, demonstrating a diverse set of anatomic and clinical characteristics. First described in 1950 by Abbott, to date there are approximately less than 70 published cases. Given the paucity of literature and no well-defined consensus on management, it is critical that we continue to add to the current body of literature. We present a case report of a young, healthy male presenting to the emergency room with pulmonary emboli, found have a large 9.0 cm IVC aneurysm which was resected and successfully repaired using a Dacron interposition graft.

Methods: A 24 year-old male with a past medical history of ‘childhood aneurysm’ and herpes simplex virus visited a local emergency department for acute onset shortness of breath after returning from a transcontinental flight, as a commercial pilot. Computed tomography of pulmonary arteries demonstrated bilateral pulmonary emboli, as well as a large IVC aneurysm measuring approximately 13.6cm craniocaudal in length by 7.6cm in transverse diameter (Figure 1).

Results: After initial work up, he was discharged to home with ongoing oral anticoagulation therapy and vascular surgery outpatient follow up. He subsequently underwent open surgical resection of the IVC aneurysm and interposition graft IVC reconstruction using a 30mm Rifampin impregnated Dacron graft (Figure 2,3). As of this report, approximately 1 month following repair, the patient is continuing to do well and is ongoing evaluation for clinical improvement and surveillance.

Conclusion(s): Inferior vena cava (IVC) aneurysms are rare, often asymptomatic entities reported only in a series of case reports in current literature. They consist of abnormal venous dilations of primary (congenital) or secondary origin. While published case reviews have described their low prevalence, presentations, and proposed options for contemporary management, IVC aneurysms remain poorly understood. Still, despite an extremely rare prevalence, they pose an increased risk of significant venous thromboembolic events. The current case highlights the association of large IVC aneurysms and potentially life-threatening thromboembolic complications, while providing a surgical reconstructive option for successful treatment.