Inferior Vena Cava Syndrome

Inferior vena cava syndrome (IVCS) is an infrequent but potentially life-threatening condition resulting from obstruction of the inferior vena cava (IVC), leading to impaired venous return. Hepatic vena cava syndrome is a rare cause of IVCS. We report the case of a 58-year old man with a complex medical and surgical history who presented with abdominal pain and distension. He had cirrhosis of the liver with moderate ascites, and diagnostic paracentesis confirmed spontaneous bacterial peritonitis. The patient developed refractory hypotension requiring vasopressors, encephalopathy, and hypoxic respiratory failure necessitating mechanical ventilation. Imaging revealed severe focal stenosis of the subdiaphragmatic IVC with preserved hepatic and portal venous patency, raising concern for IVCS. The patient underwent interventional radiology-guided percutaneous transluminal balloon angioplasty of the stenotic segment of the IVC, resulting in prompt improvement in hemodynamic status. This case highlights IVCS as an under-recognized cause of obstructive shock and underscores the importance of prompt recognition and endovascular intervention to avert morbidity and mortality in this subset of patients.