Incidental Heterotaxy Syndrome With Polysplenia and Inferior Vena Cava Agenesis Identified During Trauma Evaluation

TL;DR

A young man involved in a car accident had a CT scan that revealed rare anatomical abnormalities, including a missing inferior vena cava and multiple spleens, which have important clinical implications.

Contribution

The paper presents a rare case of heterotaxy syndrome with polysplenia and inferior vena cava agenesis identified during trauma evaluation.

Findings

Inferior vena cava agenesis increases the risk of venous thromboembolism, requiring thromboprophylaxis in trauma and surgery.

Venous anomalies should be documented to guide future procedures and ensure patient safety.

Asymptomatic intestinal malrotation in adults can often be managed with surveillance rather than surgery.

Abstract

This case report describes a young adult male in his 20s who was admitted following a high-speed motor vehicle collision resulting in polytrauma, including a femoral shaft fracture. Initial computed tomography performed for polytrauma incidentally revealed heterotaxy syndrome with polysplenia; agenesis of the inferior vena cava with hemiazygos continuation; and intestinal malrotation. Orthopedic management proceeded uneventfully.

This case highlights several important learning points: inferior vena cava agenesis is associated with an increased risk of venous thromboembolism, necessitating heightened awareness and appropriate thromboprophylaxis in trauma and perioperative settings; associated venous anomalies should be clearly documented to inform future procedural planning and patient safety; and asymptomatic intestinal malrotation identified in adulthood can often be managed conservatively with surveillance rather than intervention.

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