Nonseminomatous Germ Cell Testicular Tumour With Metastatic Retroperitoneal Lymphadenopathy Presenting As Severe Backache Due To Ivc Thrombosis

IVC thrombosis is often under-recognized. Malignancy can cause spontaneous IVC thrombosis due to its prothrombotic potential. Malignant tumors can compress, adhere or infiltrate the IVC wall causing endothelial damage with subsequent thrombosis. Retroperitoneal lymphadenopathy can cause compressive distortion of IVC causing venous stasis and turbulent flow. Metastatic retroperitoneal lymphadenopathy from testicular tumor is a rare cause of IVC invasion with resultant IVC thrombosis which can rarely present as backache. High index of suspicion is needed to detect primary testicular tumor in cases of IVC thrombosis, especially in young individuals. A 26 -year old male presented with lower back ache, weight loss and fever. MRI Lumbosacral spine done outside showed a soft tissue signal intensity retroperitoneal mass in aortocaval region compressing IVC. Ultrasound (done outside) revealed mild right sided hydroureteronephrosis secondary to a lobulated heterogeneous mass in inter-aortocaval region encasing right ureter and invading IVC causing thrombosis. Contrast enhanced Computerized axial tomography of abdomen showed a heterogeneously enhancing lobulated mass with multiple internal calcifications, in inter-aortocaval region at L3-4 level invading the IVC causing IVC thrombosis. Both tumor thrombus and bland thrombus were present. The right testis showed a subtle 10x10 mm hypodense lesion with peripheral calcification. DW-MRI showed diffusion restriction in retroperitoneal mass and the IVC tumor thrombus. Possibility of primary testicular tumor with metastatic retroperitoneal lymphadenopathy causing IVC invasion with resultant thrombosis was considered which was confirmed on histopathology examination.