부산대학교 도서관

A 54-year-old man was clinically diagnosed with diabetes mellitus in 1995, but was not treated. From the end of August 2001, he suffered from lumbar pain and several days later, edema of the right lower limb appeared. Edema also gradually developed on the left lower limb and he was admitted into our hospital on September 20, 2001. The results of physical examination on admission revealed pitting edema of the bilateral lower limbs and dilatation of superficial veins of the bilateral lateroabdominal regions. In the contrast enhanced computed tomography of thoracico-femoral region, we had the interesting findings that inferior vena cava (IVC) lower than the level of the inflow region of hepatic veins was not visualized while the azygos and hemiazygos veins were markedly dilated. Furthermore, vascular lumina were continuously filled with organized thrombi from the bilateral deep femoral veins to hemiazygos veins. In magnetic resonance angiography of the thoracico-abdominal region, numerous veins were concomitantly visualized that were regarded as collateral circulation. Based on these results, the diagnosis was absence of the IVC associated with extensive deep vein thrombosis (DVT). Due to extensive development of collateral circulation, edema in both lower limbs was ameliorated through conservative therapy. It seems likely that stagnation in blood flow can develop in the case of absence of the IVC due to the resulting abnormal perfusion. However, the clinical manifestation of DVT has been rarely reported. In the present case, however, complications associated with diffuse DVT were observed and this may be attributed to the fact that low food intake due to severe lumbar pain caused dehydration resulting in increased blood viscosity. In addition, the immobility of the patient may have contributed to the enhanced tendency toward blood coagulation occasionally seen under diabetic condition.