Calcification in the Inferior Vena Cava

Abstract

Calcification in the abdomen o f children is usually associated with a serious abnormality such as meconium peritonitis, neuroblastoma, teratoma, intrahepatic hemangioma, or hepatoma. Abdominal calcifications in adults may be related to more benign conditions such as calcified adrenal or splenic cysts, renal calculi, common vascular calcifications, and rarely calcifications in the portal veins and its tributaries associated with Banti's syndrome (3) or cirrhosis of the liver (8). Recently we have observed two patients, a newborn infant and an adult, with an uncommon calcification in the abdomen. It is the purpose of this paper to present detailed reports with respect to these patients and to discuss this curious calcification which was found in the inferior vena cava. Case Reports Case I: J. A. weighed 5 lb. 1 oz. at birth. According to history, his mother was hypertensive during pregnancy. Otherwise, her pregnancy was normal. The baby was jaundiced at birth and was hypo-active. Adynamic ileus was suspected. A normal bowel gas pattern and a retroperitoneal calcification were seen on abdominal roentgenograms. The differential diagnosis was teratoma, neuroblastoma, and calcification in the adrenal. At a staff radiology conference the diagnosis of calcification in the inferior vena cava was made. At the age of four days the child vomited about 30 ml of bile. Intestinal obstruction was suspected. On views of erect anterior, posterior, and lateral roentgenograms of the abdomen a dilated loop of jejenum and air-fluid levels in the bowel were seen along with the retroperitoneal calcification (Fig. 1). The baby did fairly well on conservative therapy but remained hypoactive and was thought to have had sepsis although blood cultures were negative. On three determinations the total serum bilirubin was about 10 mg/100 ml and the one minute direct bilirubin 1 mg/100 ml. His blood type was OMN/ cde/cde negative and his mother's ON/cde/ce positive. Two Coombs's tests were negative (false negatives may occur with blood group incompatibilities) (6). His hemoglobin was 18.6 mg/100 ml at the age of two days and 14.4 mg/100 ml at the age of eight days. The child was given intravenous fluids and he improved. He was able to take oral feedings at the age of eight days. Further studies in an attempt to investigate the cause of his vomiting and abdominal calcification included a barium enema, gastrointestinal series, and intravenous urography all of which were normal. A breast abscess developed due to Staphylococcus aureus when the infant was twenty-four days old. He was given one injection of penicillin and died immediately, presumably because of an allergic reaction. At autopsy, adhesions of the small bowel were found, which were thought to have produced partial, intermittent intestinal obstruction.