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.
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Published online: April 22, 2022
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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