Intractable radicular and low back pain secondary inferior vena cava stenosis associated with Budd-Chiari syndrome: endovascular treatment with cava stenting: case report and review of the literature

Abstract

Study design: The present report describes treatment of enlarged lumbar epidural veins in a patient with Budd-Chiari syndrome presenting with intractable radicular and low back pain.

Objective: To present a rare cause of radicular pain. To offer a case successfully to be treated with stenting of inferior vena cava stenosis.

Summary of background data: Epidural venous engorgements due to inferior vena cava thrombosis have been described previously in the literature. To the authors' knowledge, this is the first case of inferior vena cava stenosis to be treated with stenting.

Methods: An 27-year-old woman presented with intractable radicular and low back pain refractory to medical treatment. She was diagnosed with Budd-Chiari syndrome for 23 years. A venography revealed severe stenosis at the hepatic portion of the inferior vena cava causing symptomatic lumbar epidural venous engorgements.

Results: Inferior vena cava stenosis was dilatated with endovascular stenting. Her symptoms were completely resolved after this procedure.

Conclusions: Inferior vena cava stenosis related to hypertrophied caudate lobe producing lumbar epidural venous engorgements should be considered as one of the causes of radicular and low back pain. We could obtain a favorable clinical outcome by handling the primary cause of the venous engorgement.