Inferior vena cava thrombosis-rope ladder sign

Wien Med Wochenschr. 2023 May;173(7-8):159-160. doi: 10.1007/s10354-021-00886-y. Epub 2021 Oct 6.


Congenital heart disease comprises one of the largest groups of congenital defects, affecting approximately 1% of births. Advances in pre- and postoperative critical care treatment as well as surgery and interventional procedures have improved survival rates, but treatment and long-term care of children with complex congenital heart disease remains challenging, and is associated with a number of complications.Here, we report on a 17-month-old infant with congenital univentricular heart disease who devloped post-operatively inferior vena cava (IVC) thrombosis. IVC thrombosis was confirmed by a bedside contrast media study (X-ray) demonstrating collateral paravertebral circulation along the paravertebral sinuses bilaterally into the azygos and hemiazygos vein ("rope ladder sign"), with no contrast media detected in the IVC. The infant was subsequently started on aspirin and clopidogrel.

Keywords: Children; Congenital heart disease; Rope ladder sign; Thrombosis; Univentricular heart/pathology.

MeSH terms

  • Azygos Vein / abnormalities
  • Child
  • Collateral Circulation
  • Heart Defects, Congenital*
  • Humans
  • Infant
  • Vena Cava, Inferior / abnormalities
  • Vena Cava, Inferior / diagnostic imaging
  • Vena Cava, Inferior / surgery
  • Venous Thrombosis* / diagnostic imaging
  • Venous Thrombosis* / surgery