We report an uncommon case of inferior vena cava (IVC) and portal vein obstruction due to large hepatic cysts, resulting in collateral azygos, hemiazygos and paralumbar venous drainage. A venogram of the IVC to exclude thrombosis was performed, followed by percutaneous aspiration and drainage of the hepatic cyst. Upon aspiration, subsequent venogram redemonstrated extensive collateral flow through the azygos and spinous systems, with ongoing minimal flow through the portocaval system.

An 80-year-old gentleman presented to his general practitioner with isolated complaints of bilateral lower limb oedema. He underwent extensive workup, including near-normal echocardiography, doppler ultrasound of the lower limbs as well as serology. A contrast-enhanced CT scan of the abdomen and pelvis was performed, showing numerous liver lesions with appearances consistent with simple hepatic cysts, the largest of which was 176x116mm, abutting the IVC. He was referred for a venogram to exclude thrombosis in the IVC due to extrinsic compression and subsequent venous stasis. The...

Previous reports of extrinsic compression of the IVC due to hepatic cysts exist in literature[1, 2]. Kajihara[3] describes a similar case of IVC obstruction due to a large simple hepatic cyst, however following aspiration, the authors describe resolution of the obstruction. Additionally, Moon et al[4] describe a case of similar presentation (with bilateral lower limb oedema), where the patient was subsequently found to have an IVC obstruction due to a large hepatic cyst. However, a coincident large IVC thrombosis and pulmonary embolism were found and...

We present a case of IVC and portal vein obstruction due to large hepatic cysts, with drainage through collateral azygos and paralumbar venous systems. Despite aspiration and drainage of the largest hepatic cyst to relieve compression, minimal venous flow was seen through the portocaval system.

Musielak MC, Singh R, Hartman E, Bernstein J. Simple hepatic cyst causing inferior vena cava thrombus. Int J Surg Case Rep. 2014;5(6):339-41. Macutkiewicz C, Plastow R, Chrispijn M, Filobbos R, Ammori BA, Sherlock DJ, et al. Complications arising in simple and polycystic liver cysts. World J Hepatol. 2012;4(12):406-11. Kajihara Y. A Hemorrhagic Hepatic Cyst Leading to Compression of the Inferior Vena Cava. cmj. 2019;55(2):116-7. Moon J, Heo D, Han S. A case of hepatic cyst-induced inferior vena cava thrombosis. Pak J Med Sci. 2014;30(3):667-70.