May-Thurner syndrome caused by a huge uterine myoma

Venous Stasis Ulceration due to Massive Splenomegaly Causing Iliac Vein Compression From Secondary Myelofibrosis

Venous stasis ulcers are nonhealing lesions due to venous hypertension secondary to valvular dysfunction or deep venous outflow obstruction. We describe a case of a 71-year-old male with a history of polycythemia vera, secondary myelofibrosis, and massive splenomegaly up to 38 cm who presented with chronic, perimalleolar venous stasis ulcers and pain on the left lower extremity. CT showed significant compression of the left common iliac vein due to mass effect from the spleen. He was managed medically while being evaluated for partial splenic artery embolization but expired due to other chronic conditions before any intervention could be performed. Partial splenic artery embolization may be considered as a treatment option for patients with symptomatic iliac vein compression due to massive splenomegaly secondary to myelofibrosis, as long as extramedullary hematopoiesis is not compromised.

Venous thromboembolism in a patient with an uncommon etiology of May-Thurner syndrome

May-Thurner syndrome (MTS) consists of common iliac vein compression from an extrinsic source. Patients with MTS can present with a variety of symptoms, potentially making the diagnosis difficult. Classically, MTS will result in left iliac vein compression from the right iliac artery. In rare cases, it can be secondarily caused by compression from other anatomic structures in the pelvis. We present the case of a 43-year-old woman with MTS with iliofemoral deep vein thrombosis and pulmonary embolism caused by a large uterine leiomyoma. Our findings underscore the need to consider various etiologies of venous compression in patients with extensive unilateral venous thromboembolism.