Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2018; 10(11): 887-891
Published online Nov 27, 2018. doi: 10.4254/wjh.v10.i11.887
Trapped vessel of abdominal pain with hepatomegaly: A case report
Sirisha Grandhe, Joy A Lee, Ankur Chandra, Christopher Marsh, Catherine T Frenette
Sirisha Grandhe, Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, CA 95817, United States
Joy A Lee, Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA 92037, United States
Ankur Chandra, Department of Vascular Surgery, Scripps Green Hospital, La Jolla, CA 92037, United States
Christopher Marsh, Catherine T Frenette, Scripps Center for Organ Transplant, Scripps Green Hospital, La Jolla, CA 92037, United States
Author contributions: Grandhe S and Lee JA designed and wrote the report; Chandra A collected the patient’s data and contributed the images; Marsh C and Frenette CT collected the patient’s clinical data and edited the paper.
Informed consent statement: The patient agreed to allow her case to be published including any relevant laboratory data and images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Catherine T Frenette, MD, Academic Research, Attending Doctor, Doctor, Scripps Center for Organ Transplant, Scripps Green Hospital, 10666 North Torrey Pines Road, La Jolla, CA 92037, United States. frenette.catherine@scrippshealth.org
Telephone: +1-858-5544310
Received: June 4, 2018
Peer-review started: June 4, 2018
First decision: July 10, 2018
Revised: August 15, 2018
Accepted: October 10, 2018
Article in press: October 10, 2018
Published online: November 27, 2018
Processing time: 176 Days and 20.4 Hours
ARTICLE HIGHLIGHTS
Case characteristics

Patients who present with abdominal pain and hepatomegaly are commonly diagnosed as having Budd Chiari or another type of obstruction of the inferior vena cava (IVC) whether it is intrinsic due to thrombosis or an obstruction. However, extrinsic compression, although rare, can also be the culprit of the patient’s symptoms.

Clinical diagnosis

Right upper quadrant and epigastric pain and hepatomegaly.

Differential diagnosis

Budd Chiari, infective phlebitis, intravascular obstruction, thrombosis, or external compression from neighboring structures including the diaphragm, kidney, or uterus.

Laboratory diagnosis

Complete blood count, comprehensive metabolic panel, coagulation panel, in addition to labs evaluating causes of cirrhosis including ferritin, anti-mitochondrial antibody, anti-smooth muscle antibody, antinuclear antibody, and ceruloplasmin.

Imaging diagnosis

Color doppler sonography and contrast-enhanced computed tomography, magnetic resonance imaging, or venography.

Pathological diagnosis

Sinusoidal congestion with dilatation in the perivenular areas, features consistent with extrahepatic venous outflow obstruction.

Treatment

Portocaval shunts or balloon angioplasties with stent implantation.

Related reports

A case of IVC compression from the diaphragm has been reported only once in the literature from Louisiana State University Health Science Center in a patient with Pectus Excavatum. Interestingly an article from 1992 demonstrated how radiography can help identify how the IVC can be obstructed, but never specifically discussed a case in which the IVC was externally compressed by the diaphragm.

Experiences and lessons

This case will guide clinicians to think of other etiologies that can cause abdominal pain and hepatomegaly in patients with unremarkable laboratory data. Biopsies are not necessary for this diagnosis. With consideration of this diagnosis, patient care will be expedited with quicker referrals, thereby minimizing the delay in treatment and resolution of symptoms.