Inferior Vena Cava Thrombosis in Its Juxtaright Atrial Segment Diagnosed by Transthoracic Echocardiography: A Case Report from Sub-Saharan Africa

Background: Inferior vena cava (IVC) thrombosis is an uncommon but clinically significant form of proximal deep venous thrombosis, accounting for 4% - 15% of all venous thromboembolic events. When the thrombus extends into the juxtaright atrial segment of the IVC, it carries an elevated risk of fatal pulmonary embolism and intracardiac complications. In sub-Saharan Africa, this condition remains largely underreported, partly due to limited access to advanced imaging modalities. Case Presentation: We report the case of a 66-year-old hypertensive male who presented to the Department of Cardiology B at the University Hospital of Brazzaville, Republic of Congo, with bilateral lower-limb oedema following a prolonged journey. His past medical history was notable for congestive heart failure with moderate left ventricular systolic dysfunction (January 2025), a type 1 cardiorenal syndrome, and a strong clinical suspicion of hepatocellular carcinoma based on painless hepatomegaly, markedly elevated alpha-fetoprotein, and elevated liver enzymes. Two-dimensional transthoracic echocardiography (TTE) using a subcostal view identified a thrombus measuring 20 × 9 mm within a dilated IVC (25 mm), extending to its juxtaright atrial portion. Venous duplex ultrasonography of the lower limbs was unremarkable. Laboratory workup revealed normochromic normocytic anaemia (haemoglobin 10 g/dL) and mild renal impairment (creatinine 16.8 mg/L; eGFR 52.99 mL/min). The patient was initiated on rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg once daily), alongside losartan, spironolactone, dapagliflozin, rosuvastatin, and vitamin E. Bilateral oedema resolved by day 14; however, the IVC thrombus persisted. Given the unavailability of mechanical thrombectomy in Congo, the patient was referred to Morocco, where the procedure was performed in October 2025. Anticoagulation was continued upon discharge. One month later, the patient died suddenly at home; no autopsy was performed. Conclusion: This case highlights the diagnostic value of TTE in identifying juxtaright atrial IVC thrombosis in resource-limited settings, where MRI and CT angiography may not be readily accessible. Prolonged immobilisation during travel, combined with an underlying hypercoagulable state related to suspected hepatocellular carcinoma, likely contributed to thrombus formation. Prompt initiation of direct oral anticoagulants, as recommended by current ESVS guidelines, was feasible and clinically beneficial. The lack of on-site interventional vascular facilities remains a