Management of traumatic blunt IVC injury

Abstract

Introduction: Injuries to the inferior vena cava (IVC) secondary to blunt trauma are rare and occurs in less than 1% of all blunt trauma patients. Mortality rates for IVC injuries reported in the literature range from 34% to 70%. Inferior vena cava (IVC) pseudoaneurysms resulting from these injuries are also rare clinical entities with an uncertain natural history due to limited follow-up information.

Case presentation: This case report describes a 23-year-old woman with traumatic IVC dissection resulting in pseudoaneurysms. It also details our treatment plan, with follow-up through radiographic resolution of the pseudoaneurysms.

Discussion: Due to rarity of these injuries, management of these injuries has not been subjected to major studies, but several case reports and small retrospective studies have demonstrated that management can be tailored to the hemodynamic status of the patient. Stable patients whose injuries have achieved local venous tamponade have been successfully treated without surgical intervention, while unstable patients require operative management.

Conclusion: Of all incoming patients, IVC injuries are highly fatal with mortality rates between 70 and 90%. Management of these injuries should be tailored based on hemodynamic stability of such patients.

Keywords: Accidents, traffic; IVC/injuries; Management; Pseudoaneurysm.

Fig. 1

a. An axial image from the patient’s initial computed tomography study demonstrates a pseudoaneurysm along the posterior aspect of the suprahepatic inferior vena cava (IVC). b. Coronal image demonstrates focal irregularity of the IVC at the confluence with the right hepatic vein.

Fig. 2

A sagittal image from the patient’s repeat computed tomography study demonstrates stable pseudoaneurysm along the confluence of the suprahepatic inferior vena cava (IVC).

Fig. 3

a. Axial computed tomography image taken approximately 6 month after the initial caval injury demonstrates interval resolution of the traumatic pseudoaneurysm of the suprahepatic inferior vena cava (IVC); b. Coronal image demonstrates resolution of the IVC at the confluence with the hepatic veins.