Large inferior vena cava tumor with cardiac extension revealed by venous thrombembolism in a patient with complete situs inversus: what are the odds?

Venous thromboembolism (VTE) can be the fi rst symptom of an occult malignancy in apparently healthy individual. Inferior vena cava (IVC) tumors are rare conditions but with negative prognosis. We present the case of a 57 year-old male patient, with complete situs inversus, diagnosed with hepatic cirrhotic disease and frequent decompensations, that was hospitalized for deep venous thrombosis (DVT) and ascites. Further imagistic investigations revealed a 22 cm tumor inside the IVC with consequent Budd-Chiari syndrome that was actually causing the liver and kidney disease, extending from the infrarenal level to the right atrium. After compensation, the patient was referred to a multidisciplinary surgical team. However, the management of such patients is very diffi cult, and the prognosis is altered. Possible IVC leiomyosarcoma are very rare and such vascular extension has been rarely reported.

TOTAL SITUS INVERSUS WITH COR TRIATRIATUM SINISTER WITH SUPRAMITRAL RING IN AN ADOLESCENT

Cor triatriatum sinister is a rare congenital anomaly in which a membrane divides LA into two distinct chambers, supramitral ring is another membrane dividing LA. Combination of both these defects is very rare and these occurring in tandem with complete situs inversus with associated VSD are rarer still. 12 year old female with h/o dyspnea and a systolic murmur presented with complete situs inversus with cor triatriatum sinister with supramitral ring with VSD. Cor triatriatum sinister and supramitral ring and complete situs inversus is a very rare congenial disorder that can be confused clinically with congenital mitral stenosis but can be adequately diagnosed with transthoracic echocardiography and surgical correction is the definitive cure for these anomalies although percutaneous approach can also be tried.