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Requests for reprints should be addressed to Etienne Riviere, Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, 33604 Pessac, France.
Department of Internal Medicine and Infectious Diseases, Haut-Leveque Hospital, University Hospital of Bordeaux, Pessac, FranceUniversity of Bordeaux, Inserm U1034, Pessac, France
A 60-year old man presented to our unit for iterative episodes of lipothymia and prominent
superficial collateral venous circulation of the trunk (Figure A) after he was lost to follow-up for 4 years. He received 2 successive bone marrow
transplantations in 2012 for dendritic cell leukemia. Heterozygous prothrombin G20210A mutation was found after a superior vena cava thrombosis from the implantable port
occurred in 2015 with a recurrence in 2016 after anticoagulation was stopped. In 2017,
a 12-cm long stent was implanted in the superior vena cava, and tinzaparin was given.
The newly performed computed tomography scan evidenced a complete superior vena cava
stent thrombosis (Figure B, yellow arrow) with important derivations joining the central venous circulation
through femoral veins (Figure C, blue arrows) while he was still receiving tinzaparin. No other underlying cause
was found. Rivaroxaban was started and the patient was discharged.
Figure(A) Superior vena cava syndrome with a wide superficial collateral venous circulation
drawing blood from the upper body; (B) three-dimensional computed tomography reconstruction in coronal view evidencing
the stent thrombosis in the superior vena cava (yellow arrow); (C) coronal view turned three-quarters to the right showing the collateral venous circulation
of the upper body joining the central venous return through femoral veins (blue arrows).
