# 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.

## Key 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.