2022 Volume 86 Issue 6 Pages 1022-
A 57-year-old woman with no previous medical history developed coronavirus disease 2019 (COVID-19) and was placed on a ventilator due to severe pneumonia. However, she could not maintain adequate oxygenation even with administration of 100% oxygen, even though the contrast-enhanced computed tomography (CT) examination showed normal inferior vena cava (IVC) without stenosis (Figure A). V-V extracorporeal membrane oxygenation (ECMO) was introduced with right internal jugular vein cannulation and right femoral vein decannulation. Subsequently, COVID-19 infection settled down, but the patient could not be withdrawn from V-V ECMO due to severe lung injury. Thus, she underwent bilateral living-donor lung transplantation on day 103 after admission, and was successfully withdrawn from both V-V ECMO and the ventilator.
Contrast-enhanced CT examination (A) before ECMO placement, (B) after lung transplantation, (C) after development of edema, and (D) after endovascular treatment. Angiography of the IVC (E) before and (F) after endovascular treatment. Red arrows indicate the IVC. CT, computed tomography; ECMO, extracorporeal membrane oxygenation; IVC, inferior vena cava.
On postoperative day (POD) 8, contrast-enhanced CT examination showed mild stenosis of the IVC without occlusion (Figure B). She gradually developed edema with pain in both lower extremities, resulting in difficulty in walking. Contrast-enhanced CT examination on POD 76 suggested the IVC was completely occluded from the intrahepatic IVC to above the renal vein (Figure C). Despite administration of unfractionated heparin with adequate intensity, the symptoms did not improve, and endovascular treatment for IVC occlusion was performed on POD 99.
Initial angiography revealed total occlusion of the IVC (Figure E). Endovascular treatment was performed with balloon dilation, resulting in improved blood flow of the IVC (Figure F). After the procedure, the pain improved significantly, which enabled her to walk without difficulty. On the 6th day after the procedure, contrast-enhanced CT examination showed a patent IVC (Figure D).
The current patient, who dedicated herself to the treatment of patients with COVID-19 as a courageous nurse and developed COVID-19 infection, strongly hopes that this imaging report will help other patients and healthcare providers.
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