Extrinsic Compression of the Inferior Vena Cava by a Lumbar Osteophyte: A Rare Cause of Pulmonary Embolism

Pulmonary embolism results from thrombus migration into the pulmonary artery, with the most common cause being deep vein thrombosis. However, pulmonary embolism might not necessarily originate in the lower extremities, which necessitates specific diagnostic and therapeutic choices.
An 84-year-old man presented with acute pulmonary embolism, but with no sign of deep vein thrombosis or a thrombophilic state. He experienced complete resolution with medical therapy involving parenteral and oral anticoagulants. During the patient’s hospital stay, an abdominal CT scan revealed a 23 mm lumbar osteophyte compressing and displacing the inferior vena cava. The turbulent blood flow through the stenotic area might have caused a thrombus and the consequent pulmonary embolism.
This is the first report of pulmonary embolism caused by inferior vena cava extrinsic compression due to an osteophyte. Such a diagnosis should be suspected if the patient lacks deep vein thrombosis and hypercoagulative states. Acute pulmonary embolism could be a rare consequence of osteoarthritis in the spine, although correct assessment is crucial to initiating lifelong oral anticoagulant therapy following the first episode of pulmonary embolism. Indeed, spinal surgery is generally avoided due to the high risks and the fact that extrinsic compression of the inferior vena cava cannot be radically resolved.