Absent inferior vena cava resulting in exercise-induced epidural venous plexus congestion and XXXX : a case report and review of the literature.

@entity1 @entity5337 @entity1183 @entity455 @entity66 @entity1746 @entity1150 @entity715
STUDY DESIGN: Case report and clinical discussion. OBJECTIVE: To describe a unique etiology for a @entity1 presenting with exercise-induced @entity1746 found to have agenesis of the infrarenal inferior vena cava (IVC) and a large vein draining the confluence of the iliac veins through the L4 foramen into the epidural plexus. SUMMARY OF BACKGROUND DATA: @entity66 are infrequently determined to be the etiology of nerve root compression syndromes. Such cases have been described in @entity1 with absent IVC with @entity715 . We are unaware of any previously described cases of absent IVC with a primary route of venous return through the epidural venous plexus, resulting in symptoms in the absence of @entity715 . METHODS: We describe a case of a 34-year-old @entity1 who presented complaining of @entity1183 of legs as well as cauda equina symptoms occurring during exercise. He was found to have infrarenal absence of the IVC with the confluence of the iliac veins forming a large draining vein which entered the L4 foramen into the epidural venous plexus. Pre- and postexercise magnetic resonance imaging scans were performed to compare change in the size of the plexus. RESULTS: Postexercise magnetic resonance imaging showed notable increase in the volume of the epidural venous plexus of the lower lumbar spine. The @entity1 was referred to neurosurgery and vascular surgery, which did not intervene. On follow-up 2 years later, the @entity1 developed significant right @entity1150 and was found to be heterozygous for @entity5337 mutation. CONCLUSION: This case demonstrates the breadth of anatomic and physiologic understanding a clinician must draw on when approaching @entity1 with nerve root compression symptoms. It is also pertinent to consider performing a hypercoagulable work-up in @entity1 with @entity455 , as this may prevent future @entity715 .
