A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having several weeks of leg swelling. The patient has a 40-pack-year smoking history but does not use alcohol or illicit drugs. He is afebrile and vital signs are within normal limits. On physical examination, there is symmetric pitting edema of the lower extremities bilaterally. The abdomen is soft and nondistended. A mobile left flank mass can be palpated. There are several vertically oriented tortuous veins on the lower abdominal wall. Which of the following structures is most likely obstructed in this patient?

Question

A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having several weeks of leg swelling. The patient has a 40-pack-year smoking history but does not use alcohol or illicit drugs.  He is afebrile and vital signs are within normal limits.  On physical examination, there is symmetric pitting edema of the lower extremities bilaterally.  The abdomen is soft and nondistended.  A mobile left flank mass can be palpated.  There are several vertically oriented tortuous veins on the lower abdominal wall. Which of the following structures is most likely obstructed in this patient?

Quizplus · Accepted Answer

Eductional Objective: Renal cell carcinoma tends to invade the renal vein; inferior vena cava obstruction can occur by intraluminal extension of the tumor.  Obstruction of the inferior vena cava produces symmetric bilateral lower extremity edema, often associated with prominent development of venous collaterals in the abdominal wall.

A 63-Year-Old Man Comes to the Physician Because of a 3-Month