Dr. Kaufman presented a case of a young male with active IVDU and homelessness who presented with acute progressive RUQ pain with nausea, found to have hypercalcemia, elevated alk phos, and CT abdomen evidence of RCC with invasion into the R renal rein and IVC with associated tumoral thrombosis.
We discussed the large ddx of a young person presenting with abdominal pain in the setting of IVDU including many of the "itis" diagnoses including pancreatitis, hepatitis, cholecystitis, appendicitis as well as intraabdominal abscesses/infection given his IVDU history. Concern for malignancy rose after labs returned with hypercalcemia and elevated alk phos in our patient.
Dr. Kaufman discussed how there are no specific guidelines regarding anticoagulation for IVC thrombosis and we reflected on various approaches in this specific setting (tumor-associated IVC thrombosis from RCC). Ultimately, the best approach is a multidisciplinary one with medicine, oncology, and our surgical colleagues.
Dr. Kaufman also reviewed an RCT published in Lancet 2014 that evaluated whether compression stockings prevented post-thrombotic syndrome. The conclusion of the study was that there was no difference in the compression group compared to placebo group, thus the study did not support the use of compression stockings to prevent post-thrombotic syndrome.