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Kelly R, Blecha M. Recanalization of Inferior Vena Cava and Bilateral Iliac Veins 15 Years after May-Thurner Syndrome-Related Occlusion. Am Surg 2023; 89:6317-6319. [PMID: 36951056 DOI: 10.1177/00031348231167394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
May-Thurner syndrome (MTS) is a relatively rare condition involving mechanical compression of a vein between an artery and a bone which may result in venous stenosis, reflux, occlusion, or deep vein thrombosis (DVT). The most common location for MTS to occur is the left iliocaval confluence, specifically where the left common iliac vein crosses under the right common iliac artery and becomes compressed against a vertebral body. Our case represents a unique presentation of MTS where a missed diagnosis of MTS during a presentation of acute LLE DVT over 15 years ago which would later progress to chronic bilateral iliac vein occlusion and IVC obliteration. This also ultimately contributed to recurrent left lower extremity (LLE) DVT. The hypothesis for this case is that our patient had May-Thurner syndrome at the time of his original LLE DVT 15 years ago that went undiagnosed. He likely had "spillover" thrombus that occluded the right iliac venous system and resulted in IVC thrombosis at that time. What resulted was obliteration of the IVC between the iliac vein confluence and the renal vein level and bilateral iliac veins. The chronicity of the occlusion creates a uniqueness to this case as there are sparse reports of such longstanding ileo-caval occlusion being recanalized after such a prolonged duration.
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Affiliation(s)
- Robert Kelly
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Loyola University Health System, Maywood, IL, USA
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Lan YQ, Xi ZF, Dong JJ, Chen YM, Wang YF, Feng N. Added value of computed tomography venography in the identification of abnormities in veins of lower extremities. Curr Med Res Opin 2022; 38:927-936. [PMID: 35321594 DOI: 10.1080/03007995.2022.2057151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the efficacy of direct computed tomography venography (CTV) in early and accurate detection of lower extremity venous (LEV) abnormalities. METHODS Cross-sectional research was conducted in Hebei General Hospital of China. A total of 211 CTV reports of both lower extremities from January 2017 to September 2019, 75 color Doppler ultrasound (DUS) examinations, and eight intravascular angiography records of these patients over the same period were collected from the hospital. Comparisons were made for the reported number and percentage of LEV abnormalities (thrombosis, stenosis including severe stenosis, and varicosities). Chi-square test and t-test were applied to compare the rates and means, respectively. Significance level α was 0.05. Individual interviews were performed to understand the perceptions of medical staff and patients on the application of CTV, and the interview results were analyzed. RESULTS Of the 75 cases with both CTV and DUS reports, 159 abnormalities occurring in the lower extremity deep veins (LEDV) were reported, among which 125 (79%) and 18 (11%) were reported by CTV and DUS on a single basis, respectively, whereas 16 (10%) were reported by CTV and DUS simultaneously. A statistically significant greater number of abnormalities in LEDV were identified by CTV than DUS in both males and females (χ2males = 78.449, χ2females = 27.574, χ2total = 104.164, p < .05). In the 211 CTV reports, among the 383 abnormalities reported in total, the common iliac vein (CIV) had the highest number of reported abnormalities (132, 34.5%), followed by the femoral vein (93, 24.3%). The ratios between LEDV abnormality and patient numbers were 1.055 and 0.688 for left and right sides in males, and 0.892 and 0.461 for left and right sides in females, respectively, with that for the left side statistically significantly higher than the right one (tmale = 2.896, tfemale = 4.347, p < .05). The incidence of thrombosis was 10.9% (95% CI = 6.7 ∼ 15.1%). Reported abnormities in CIV by CTV were in agreement with those by intravascular angiography. The medical staff believed that CTV could guide the performance of surgeries for LEV and the patients perceived CTV acceptable. CONCLUSIONS Application of CTV for early and accurate detection of LEDV abnormalities including thrombosis has been proven to be efficient. Corresponding benefit in early intervention and reduction of severe complications of such abnormalities is of important value. CTV earned good recognition from medical staff and patients. Hence, it could be considered as part of global health assistance cooperation with developing countries to facilitate enhanced medical services.
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Affiliation(s)
- Yan-Qin Lan
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Zhi-Feng Xi
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Jia-Jie Dong
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Ying-Min Chen
- Imaging Department, Hebei General Hospital, Shi Jiazhuang, Hebei, P.R. China
| | - Yu-Fei Wang
- International Cooperation, China Foundation for Poverty Alleviation, Beijing, P.R. China
| | - Ning Feng
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
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Mir WAY, Shrestha DB, Aryal BB, Lord V, Verda L. May-Thurner Syndrome: An Anatomic Predisposition to Deep Vein Thrombosis. Cureus 2021; 13:e16682. [PMID: 34462701 PMCID: PMC8389860 DOI: 10.7759/cureus.16682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
May-Thurner syndrome (MTS) is a rare clinical condition caused by extrinsic compression of the left common iliac vein by the right common iliac artery, leading to venous stasis and predisposing to thrombus formation. Here, we present the case of a 39-year-old female with no obviously known other risk factors predisposing to thrombosis who presented with severe left leg pain and swelling for a week. The international normalized ratio was elevated and the venous Doppler study showed extensive thrombosis extending from the left common iliac vein to the common femoral vein and the popliteal vein. She was diagnosed with MTS and treated with catheter-directed mechanical thrombolysis and thrombectomy, along with angioplasty of the left common iliac vein and external iliac vein, with near-complete resolution post-treatment. MTS should be suspected in patients who present with unilateral limb thrombosis regardless of the presence of predisposing factors. Timely management with endovascular procedures is necessary to help prevent other potential life-threatening complications.
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Affiliation(s)
| | - Dhan B Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Barun B Aryal
- Department of Emergency Medicine, BP Smriti Hospital, Kathmandu, NPL
| | - Victoria Lord
- Department of Internal Medicine, University of Miami, Palm Beach Gardens, USA
| | - Larissa Verda
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
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García-García A, Oblitas CM, Galeano-Valle F, Olmos-Nieto A, Ortega-Soudant A, Demelo-Rodríguez P. May-Thurner syndrome and deep vein thrombosis: A series of 8 patients. Med Clin (Barc) 2021; 156:622-624. [PMID: 33810871 DOI: 10.1016/j.medcli.2020.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the prevalence of May-Thurner syndrome (MTS) among patients with deep vein thrombosis (DVT) of left lower limb (LLL), and outcomes after long-term follow-up. METHOD Retrospective observational study that included patients older than 18 diagnosed with acute DVT and MTS. RESULTS Among 760 patients diagnosed with DVT in the LLL, 8 patients were diagnosed with MTS (1.05%), with a mean age of 39 years. All patients received long-term anticoagulation, with a mean of 31.9 (±25.2) months. Invasive treatment with pharmaco-mechanical thrombectomy was performed in 5 patients (62.5%). During follow-up (mean of 32.4 months), 25% of patients suffered DVT recurrence. Only 1 case presented major bleeding, and no deaths were registered. CONCLUSIONS May-Thurner syndrome constitutes a permanent and underdiagnosed risk factor for the development of DVT of LLL. Our findings suggest that long-term anticoagulation therapy might be considered in selected cases.
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Affiliation(s)
- Alejandra García-García
- Venous Thromboembolism Unit, Internal Medicine. Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Crhistian-Mario Oblitas
- Venous Thromboembolism Unit, Internal Medicine. Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Internal Medicine. Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de investigación sanitaria Gregorio Marañón, Madrid, Spain.
| | - Andrea Olmos-Nieto
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Ortega-Soudant
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Internal Medicine. Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Instituto de investigación sanitaria Gregorio Marañón, Madrid, Spain
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Karri K, Singh T, Tripathi N, Sudanagunta K, Yarra P. Deep Venous Aberration. Cureus 2021; 13:e13782. [PMID: 33786249 PMCID: PMC7997050 DOI: 10.7759/cureus.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/01/2022] Open
Abstract
Deep venous thrombosis is a common medical diagnosis. Estimates suggest 60,000 to 100,000 deaths annually from deep venous thrombosis and related complications in the United States of America. The diagnosis is often straightforward using a combination of clinical features and ultrasonography. Once confirmed, the treatment is straightforward as well - anticoagulation. However, we might come across a case where despite the prescribed treatment, there is little clinical improvement. There could be myriad reasons for this. We wish to share our experience with one such treatment failure and how we were able to narrow down the etiology to an anatomical defect. Eventually, we were able to offer curative treatment with vessel stenting. This case refreshed our medical knowledge and we hope to do the same for our colleagues.
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Affiliation(s)
- Kishore Karri
- Internal Medicine, University of Kentucky, Lexington, USA
| | - Tushi Singh
- Internal Medicine, University of Kentucky, New York, USA
| | | | | | - Pradeep Yarra
- Internal Medicine, University of Kentucky, Lexington, USA
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Montes MC, Carbonell JP, Gómez-Mesa JE. Endovascular and medical therapy of May-Thurner syndrome: Case series and scoping literature review. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:80-89. [PMID: 33752850 DOI: 10.1016/j.jdmv.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION May-Thurner syndrome has been recognized as a cause of chronic venous insufficiency and a trigger for venous thromboembolism. There is no consensus about the definition, diagnosis, and therapeutic approach. We are aiming to describe its characteristics and a scoping literature review. METHODS A retrospective review of patients with May-Thurner syndrome from March 2010 to May 2018 and scoping literature review were made. RESULTS Seven patients were identified. All patients were female with a median age of 36 (20-60) years. The median time from the first symptom to diagnosis was 3.41 (0.01-9) years. The primary clinical presentation was post-thrombotic syndrome (4 patients). Six patients had at least one risk factor for deep venous thrombosis. All patients underwent angioplasty with stent; patients with acute deep venous thrombosis, furthermore mechanic thrombectomy with or without catheter-directed thrombolysis were done. There were three complications (one patient, lymphedema, and two venous stent thrombosis). Scoping review results were descriptively summarized. CONCLUSION May-Thurner syndrome has a varied spectrum of clinical presentation, and clinical awareness is paramount for diagnosis. Its principal complication is the post-thrombotic syndrome, which is associated with high morbidity. There is no consensus on the antithrombotic treatment approach.
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Affiliation(s)
- M C Montes
- Internal Medicine Department, Cardiology Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J P Carbonell
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia
| | - J E Gómez-Mesa
- Surgery Department, Vascular Surgery Service, Hospital Fundación Valle del Lili, Cali, CO, Colombia.
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Ignat'ev IM, Akhmetzianov RV, Volodiukhin MI. [A case of successful endovascular treatment of a patient with chronic pelvic pain and recurrent varicocele]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:42-46. [PMID: 32240135 DOI: 10.33529/angio2020111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Described in the article is a clinical case report regarding diagnosis and treatment of pelvic varicose veins in a 34-year-old male patient presenting with compressive stenosis of the left common iliac vein (May-Thurner syndrome). The man had developed clinical symptoms of the disease as varicocele when he was 17 years old. Multiple surgical interventions on the veins of the spermatic cord failed to result in significant success. The diagnosis was verified by means of ultrasound examination and contrast X-ray phlebography. The patient was subjected to balloon angioplasty and stenting of the compressive stenosis of the left common iliac vein. The endovascular treatment performed was followed by the patient's improved condition, confirmed by methods of instrumental diagnosis, as well as by regression of clinical symptomatology.
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Affiliation(s)
- I M Ignat'ev
- Vascular Surgery Department, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - R V Akhmetzianov
- Vascular Surgery Department, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - M Iu Volodiukhin
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Interregional Clinical and Diagnostic Centre, Kazan, Russia; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
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Gökçe Ş, Keskin G, Yaşar ŞK, Arslan AT, Cerit Z, Koska Öİ, Aydoğdu S. A case of May-Thurner Syndrome: An old anomaly but, a new suggestion: A case report. Malawi Med J 2020; 31:230-232. [PMID: 31839895 PMCID: PMC6895379 DOI: 10.4314/mmj.v31i3.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
May-Thurner syndrome (MTS) is an anatomical condition resulting in compression of the left common iliac vein between the right common iliac artery and the underlying spine. MTS is rarely diagnosed because diagnostic workup is seldom continued once the diagnosis of a deep vein thrombosis (DVT) has been established. Furthermore, patients with DVT generally have several well-known confounding risk factors. We report a 16-year-old girl with a history of left leg swelling who was incidentally diagnosed with MTS. We hope that our case report will create awareness of vascular abnormalities in sports medicine and suggest that routine venous Doppler ultrasound screening may help to detect MTS or associated anatomical prior to the formation of early thrombosis.
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Affiliation(s)
- Şule Gökçe
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit. Ege University, Bornova, 35040, Izmir, Turkey
| | - Gülsüm Keskin
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit. Ege University, Bornova, 35040, Izmir, Turkey
| | - Şeyma Kar Yaşar
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit. Ege University, Bornova, 35040, Izmir, Turkey
| | - Aylin Tuğba Arslan
- Ege University Faculty of Medicine, Department of Pediatrics, General Pediatrics Unit. Ege University, Bornova, 35040, Izmir, Turkey
| | - Zeynep Cerit
- Near East University, Department of Pediatric Cardiology, Nicosia, Cyprus
| | - Özgür İlker Koska
- Ege University Faculty of Medicine, Department of Radiology, Ege University, Bornova, 35040, Izmir, Turkey
| | - Sema Aydoğdu
- Professor Doctor, Ege University Faculty of Medicine, Department of Pediatrics, Ege University, Bornova
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Choy KT, Bhutia S. Recurrent unilateral cellulitis: is it May-Thurner syndrome (MTS)? BMJ Case Rep 2019; 12:12/7/e229511. [PMID: 31278199 DOI: 10.1136/bcr-2019-229511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
May-Thurner syndrome (MTS) is a differential diagnosis to be considered in a patient with recurrent unilateral cellulitis. A 73-year-old woman initially presented with recurrent unilateral cellulitis of her left lower limb. A CT scan demonstrated a stenosed left common iliac vein (CIV) narrowed at its origin by the proximal right common iliac artery consistent with MTS. The chronicity of the condition at the time of diagnosis made attempts to recanalise the CIV unsuccessful. A diagnosis of MTS should be considered in a patient with chronic unilateral limb oedema/cellulitis as it represents a potentially treatable condition if detected early.
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Affiliation(s)
- Kay Tai Choy
- Department of Vascular Surgery, Cairns Hospital, Cairns North, Queensland, Australia
| | - Sherab Bhutia
- Department of Vascular Surgery, Cairns Hospital, Cairns North, Queensland, Australia
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Abstract
May-Thurner syndrome (MTS), or iliac vein compression syndrome, is a pelvic condition that involves compression of the iliac veins resulting in endothelial damage. This condition is typically asymptomatic and often missed in primary care. As progression occurs over time, symptoms related to venous hypertension may be present including acute extremity pain and swelling, pelvic pain, venous claudication, deep venous thrombosis, or chronic development of venous insufficiency. A case report is provided to enhance primary health care providers' knowledge of MTS and promote early detection and recognition to enhance positive and expedited outcomes.
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Tello Díaz C, Allegue Allegue N, Gil Sala D, Gonçalves Martins G, Boqué Torremorell M, Bellmunt Montoya S. Cauda Equina Syndrome Caused by Epidural Venous Plexus Engorgement in a Patient with May-Thurner Syndrome. Ann Vasc Surg 2019; 60:480.e7-480.e11. [PMID: 31200048 DOI: 10.1016/j.avsg.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/12/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
The purpose of this article is to present a case of cauda equina syndrome in a patient with incomplete motor and sensory deficits due to epidural venous plexus engorgement, owing to May-Thurner syndrome successfully treated with venous iliac stenting. A 40-year-old woman, with previous history of deep vein thrombosis and miscarriages, gradually developed right leg and back pain, with functional limitation, perineal hypoesthesia, and sphincter incontinence. Magnetic resonance imaging revealed epidural venous plexus engorgement and cauda equina roots involvement. Phlebography showed perimedullary venous enlargement and left common iliac vein stenosis, leading to the diagnosis of May-Thurner syndrome. Stenting of the left common iliac vein was performed resulting in pain improvement and disappearance of neurological symptoms. Thrombophilia study was positive to heterozygous factor V Leiden. Cauda equina syndrome as the first presentation of a May-Thurner syndrome is very rare. In this case, venous iliac stent placement was an effective and safe treatment.
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Affiliation(s)
- Cristina Tello Díaz
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Nicolás Allegue Allegue
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Daniel Gil Sala
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Miriam Boqué Torremorell
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Bellmunt Montoya
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Bhadra R, Somasundaram M, Iltchev DV, Ravakhah K. Acute bilateral pulmonary embolism in a 21-year-old: is May-Thurner syndrome in our differential? BMJ Case Rep 2019; 12:12/4/e227046. [PMID: 30940666 DOI: 10.1136/bcr-2018-227046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
May-Thurner syndrome (MTS) is a clinical condition where the left common iliac vein gets compressed by the overlying right common iliac artery anterior to the fifth lumbar vertebra and the sacral promontory. It results in vessel wall injury and predisposition to thrombosis. We present a case of a 21-year-old African-American man with no significant past medical history who came to the emergency department with left lower limb swelling associated with shortness of breath, and was eventually diagnosed to have extensive left lower extremity deep vein thrombosis (DVT) along with acute bilateral extensive pulmonary embolism (PE) as a consequence to MTS. MTS should be considered in the differential when young patients present with unprovoked or recurrent left-sided DVT. Diagnosis of this anatomical variant is critical as it may need long-term anticoagulation and consideration of pharmaco-mechanical intervention such as mechanical thrombectomy and venoplasty with or without stenting.
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Affiliation(s)
- Rajarshi Bhadra
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Meyappan Somasundaram
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Daniel V Iltchev
- Department of Pulmonary and Critical Care Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Keyvan Ravakhah
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
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