Hepatic vena cava disease: Etiologic relation to bacterial infection

Aim: Hepatic vena cava disease is a primary obliterative disease of the hepatic portion of the inferior vena cava (IVC) that often causes liver cirrhosis and hepatocellular carcinoma. Its geographic prevalence is inversely related to the standard of community hygiene. The disease is endemic in Nepal and is commonly associated with bacterial infection. The cause of the disease is not known. It was previously thought to be congenital. Thrombosis due to hypercoagulable condition is suggested as a possible cause of the disease. This study looks at the relation of the disease to bacterial infection. Methods: Ultrasonography is sensitive and specific for the diagnosis of acute and chronic lesions of hepatic vena cava disease. Patients attending the Liver Clinic with pyrexia with and without bacteremia were examined by ultrasonography for acute "thrombophlebitic" lesion of the IVC, and five patients with bacterial infection with acute lesion in the hepatic portion of the IVC were followed. Results: Sixty eight percent of the patients with bacteremia had ultrasonographic evidence of acute lesion in the hepatic portion of the IVC, compared to 18% patients without bacteremia. A follow-up study of five patients showed transformation of the acute lesion into chronic obliterative lesion - stenosis or complete obstruction. Conclusion: Bacterial infection is probably the cause of hepatic vena cava disease seen in developing countries.