scholarly journals An extensive unprovoked left lower extremity deep vein thrombosis secondary to an anatomical anomaly: a case of May-Thurner syndrome

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Irfan Ahsan ◽  
Binish G. Qureshi ◽  
Ali Raza Ghani ◽  
Faizan Malik ◽  
Zulfiqar Arif
Keyword(s):  
Lower Extremity ◽  
Young Patients ◽  
Lumbar Vertebra ◽  
Rare Condition ◽  
Iliac Vein ◽  
Young Female ◽  
The Body ◽  
Common Iliac Vein ◽  
Venous Flow ◽  
Left Lower Extremity

May-Thurner syndrome (MTS) also known as Cockett’s syndrome is a rare condition responsible for 2%-3% of all cases of deep venous thrombosis (DVT). The thrombosis results from mechanical compression of the left common iliac vein against the body of the fifth lumbar vertebra by the right common iliac artery. Repetitive hyperplasia of the venous wall by compression results in spur formation that in turn causes venous flow obstruction and results in the DVT. Our case is a young female who had acute extensive proximal DVT due to MTS that was successfully managed using mechanical thrombectomy with a venous stent. MTS although a rare entity should be suspected especially in young patients with unilateral DVT with extensive clots especially on left lower extremity without any antecedent risk factors.

Do Waveforms Matter? Yes They Do! A Case in Point

2020 ◽  
Vol 44 (4) ◽  
pp. 192-197
Author(s):  
Jessica Kralec
Keyword(s):  
Lower Extremity ◽  
Continuous Flow ◽  
Pregnant Patient ◽  
Iliac Vein ◽  
Leg Pain ◽  
Common Iliac Vein ◽  
Venous Flow ◽  
Left Lower Extremity ◽  
Patient Reported ◽  
Spectral Doppler

A 38-year-old G1P0 presented to the Vascular Lab at 32 weeks gestation for evaluation of persistent left lower extremity edema. The patient reported a 1-month history of left leg pain and swelling after a long car trip. Of note, she had 3 negative lower extremity ultrasounds at outside imaging facilities over the previous 6 weeks. Left lower extremity venous duplex was performed with B-mode, color, power, and spectral Doppler using a linear 12-3 MHz transducer and curvilinear 5-1 MHz transducer. Images were documented using Intersocietal Accreditation Commission Vascular Testing (IAC VT) protocol. Left lower extremity duplex revealed continuous flow in the bilateral common femoral veins. Right common iliac and external iliac vein Doppler waveforms demonstrated spontaneous and phasic flow. Left proximal common iliac and external iliac veins revealed continuous flow. Acute, occlusive deep venous thrombosis (DVT) was identified in the left distal common iliac vein. The left common iliac vein was enlarged, measuring 2.2 cm compared with the contralateral common iliac vein measuring 1.4 cm. Ultrasonographic infrainguinal demonstration of acute DVT is straightforward and usually achievable with standard ICA VT protocol. However, imaging of the proximal pelvic venous circulation can be more elusive, particularly in the pregnant patient. Therefore, it is imperative to assess the spectral Doppler waveforms and to investigate pelvic venous flow. Because of the sonographer’s attention to the common femoral waveforms, additional focused pelvic imaging was performed and located acute, occlusive iliac DVT as the cause of significant edema.

scholarly journals Acute bilateral pulmonary embolism in a 21-year-old: is May-Thurner syndrome in our differential?

2019 ◽  
Vol 12 (4) ◽  
pp. e227046
Author(s):  
Rajarshi Bhadra ◽  
Meyappan Somasundaram ◽  
Daniel V Iltchev ◽  
Keyvan Ravakhah
Keyword(s):  
Pulmonary Embolism ◽  
Young Patients ◽  
Lumbar Vertebra ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Significant Past Medical History ◽  
Anatomical Variant ◽  
Vein Thrombosis ◽  
Left Lower Extremity ◽  
Fifth Lumbar Vertebra

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.

Clinical correlation of anatomical location of non-thrombotic iliac vein lesion

Vascular ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 359-363 ◽  
Author(s):  
Afsha Aurshina ◽  
Borislav Kheyson ◽  
Justin Eisenberg ◽  
Anil Hingorani ◽  
Arkady Ganelin ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Intravascular Ultrasound ◽  
Iliac Vein ◽  
Clinical Findings ◽  
Common Iliac Vein ◽  
Anatomical Location ◽  
Clinical Correlation ◽  
Common Site ◽  
External Iliac Vein ◽  
Left Lower Extremity

Objective Treatment of non-thrombotic iliac vein lesions is an active area of research. Intravascular ultrasound allows its localization. We chose intravascular ultrasound to clarify the exact anatomical location of non-thrombotic iliac vein lesions and correlate it with clinical findings. Materials and methods Over seven months, we performed ilio-femoral intravascular ultrasound studies on 217 patients, in 141 women and 76 men. The average age ± standard deviation was 68 ± 14 years. We used intravascular ultrasound intraoperatively to measure the ilio-femoral veins and compared it with adjacent non-stenotic ilio-femoral veins. If more than 50% area or diameter reduction was found, it was treated with appropriate balloon and stent. Results We identified 244 lesions, 124 in left lower extremity and 120 in the right lower extremity. The most common site was the proximal common iliac vein 38.7% (22.5% females and 16.12% males) in left lower extremity and middle external iliac vein 29.16% (18.33% females and 10.83% males) in right lower extremity. The least common site was the distal external iliac vein in 3.2% (all 3.2% females) and the distal external iliac vein 7.5% (5% females and 2.5% males) in right lower extremity. Clinical correlation was noted between laterality and location of the NIVL lesion ( p < 0.0001). Conclusion This analysis gives an insight into understanding the exact anatomical locations of the non-thrombotic iliac vein lesions helping clinicians and researchers guide their treatment and research.

scholarly journals Sonography’s Role in the Diagnosis of May–Thurner Syndrome

2017 ◽  
Vol 34 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Ashley Barry
Keyword(s):  
Lower Extremity ◽  
Iliac Vein ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Anatomic Variant ◽  
Left Lower Extremity ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome

May–Thurner syndrome (MTS), also known as Cockett syndrome or iliac vein compression syndrome, is a condition in which patients develop swelling, deep vein thrombosis (DVT), venous insufficiency, and other symptoms of the left lower extremity due to an anatomic variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Although it is an uncommonly diagnosed condition, it is estimated to compose up to half of cases of left lower extremity venous disease. Although having some degree of iliac vein compression is considered a normal anatomic variant in an asymptomatic patient, those who experience severe swelling, venous reflux, and DVT often have anatomically abnormal veins with a spur formation. With proper technique and proficiency, transabdominal sonography can be used as a valuable diagnostic tool in the discovery and to facilitate treatment of May–Thurner syndrome. Diagnostic ultrasound also can monitor the development of recurring DVT and identify symptoms of postthrombotic syndrome.

scholarly journals Case Report: Rare Iliac Vein Compression (May–Thurner) Syndrome in a Pediatric Patient

2021 ◽  
Vol 9 ◽  
Author(s):  
Lianfu Ji ◽  
Fan Yang ◽  
Xuan Chen ◽  
Jinlong Chen ◽  
Xueying Cheng ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Left Lower Extremity ◽  
Normal Ranges ◽  
Iliac Vein Compression ◽  
Magnetic Resonance Imaging Mri ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Iliac vein compression syndrome (IVCS) or May–Thurner syndrome occurs predominantly in young to middle-aged women. Here we reported a case of IVCS in a 5-year-old boy. The child was admitted to our vasculocardiology department with left lower extremity that had been swollen for 1 month. Blood tests revealed coagulation routine and platelets in the normal ranges. Computer tomography angiography (CTA) and magnetic resonance imaging (MRI) showed the left common iliac vein had become narrow before it entered the right common iliac vein. To further clarify, we performed angiography, which clearly showed the stenosis and the blood return of the left common iliac vein. So IVCS was diagnosed. What is more, we found the aorta descended to the right of the spine, and this may be the reason for the apparent compression of the left common iliac vein. Given the young age and mild symptoms of the child, the treatment was conservative mainly including elevation of the affected limb, wearing medical elastic socks, and short-term oral aspirin for anticoagulation. Meanwhile, the boy is being followed up closely. If the swelling of the left lower extremity significantly increases, stent placement may need to be considered in the future.

scholarly journals Atraumatic Gluteal Compartment Syndrome Presenting in a Young Female with Unilateral Lower Extremity Symptoms

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Morgan Maxon ◽  
Curt Cackovic
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Kidney Injury ◽  
Rare Condition ◽  
Young Female ◽  
Delay In Diagnosis ◽  
Presenting Symptoms ◽  
Left Lower Extremity ◽  
Gluteal Compartment Syndrome ◽  
Drug And Alcohol

Gluteal compartment syndrome is a rare condition that often develops following immobilization either secondary to illicit drug and alcohol abuse or improper surgical positioning. A case of a 22-year-old female with left lower extremity pain, weakness, and numbness after prolonged stasis from a night of drug and alcohol use is presented. She also complained of left low back pain. Her initial neurologic examination was significant for decreased deep tendon reflexes, decreased motor strength, and decreased sensation in the left lower extremity. Severe pain in the affected region persisted despite several attempts at pain control utilizing multiple modalities. An emergent MRI of the lumbar spine revealed gluteal compartment syndrome. The patient ultimately underwent emergent fasciotomy with resultant improvement in neurologic symptoms. Because presenting symptoms are frequently nonspecific in initial stages, gluteal compartment syndrome is often misdiagnosed. This can lead to unnecessary morbidity and mortality. It is important to maintain a high index of suspicion for gluteal compartment syndrome because delay in diagnosis can lead to nerve palsy, acute kidney injury, sepsis, and/or death.

scholarly journals ANOMALOUS COMMUNICATION BETWEEN RIGHT INTERNAL ILIAC VEIN AND LEFT COMMON ILIAC VEIN - A CASE REPORT

2014 ◽  
Vol 04 (03) ◽  
pp. 119-120
Author(s):  
Huban Thomas R. ◽  
Prakashbabu B. ◽  
Radhakrishnan P.
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Lumbar Vertebra ◽  
Iliac Vein ◽  
The Body ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Internal Iliac Vein ◽  
Internal Iliac

AbstractInferior vena cava (IVC) is formed by the union of the common iliac veins anterior to the body of the fifth lumbar vertebra, a little to its right side. It conveys blood to the right atrium from all the structures below the diaphragm. During routine educational dissection for medical undergraduates, we have come across a case of an anomalous communication between right internal iliac vein and left common iliac vein and a variation in the formation of inferior vena cava in a 55-year-old male cadaver. Due to its complex embryogenesis and relationship with other abdominal and thoracic structures, IVC may develop abnormally. These anatomical variations are often clinically silent and discovered incidentally. Knowledge of these variations may be helpful to clinicians and anatomists during surgical exploration, atypical clinical presentations and cadaveric findings.

Case Series of Concomitant Klippel-Trenaunay Syndrome and May-Thurner Syndrome

2021 ◽  
pp. 153857442199501
Author(s):  
John F. Charitable ◽  
Onur Yilmaz ◽  
Caron Rockman ◽  
Glenn R. Jacobowitz
Keyword(s):  
Lower Extremity ◽  
Case Series ◽  
Iliac Vein ◽  
Symptomatic Improvement ◽  
Venous Disease ◽  
Common Iliac Vein ◽  
Left Common Iliac Vein ◽  
Left Lower Extremity ◽  
The Right ◽  
Klippel Trenaunay Syndrome

Klippel-Trenaunay syndrome is a rare vascular disorder which includes leg swelling, or lower extremity deep venous reflux/thrombosis as a presenting symptom. May-Thurner syndrome is also a rare pathology involving compression of the left common iliac vein, usually by the right common iliac artery. The incidence of concomitant occurrence of these entities is unknown and not well reported. This case series describes 3 patients who underwent evaluation of symptomatic left lower extremity venous disease. All 3 suffered symptomatic Klippel-Trenaunay initially, and were subsequently diagnosed with concomitant May-Thurner Syndrome. They were successfully treated with left common iliac vein stents with symptomatic improvement.

Acute Generalized Exanthematous Pustulosis With Multiple Organ Dysfunction Syndrome

2013 ◽  
Vol 22 (3) ◽  
pp. 270-273 ◽  
Author(s):  
Ghulam Rehman Mohyuddin ◽  
Manar Al Asad ◽  
Lindsay Scratchko ◽  
Ghulam Khaleeq
Keyword(s):  
Lower Extremity ◽  
Rare Condition ◽  
Skin Condition ◽  
Multiple Organ ◽  
Drug Induced ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Left Lower Extremity ◽  
Causative Drug ◽  
Diffuse Erythema ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent.

scholarly journals Management of Phlegmasia Cerulea Dolens Caused by a Giant Leiomyoma

2021 ◽  
Author(s):  
Elisabeth Ekkel ◽  
Tara Chandran ◽  
Ryan Qasawa ◽  
Michael Trpkovski ◽  
Sachinder Hans
Keyword(s):  
Uterine Leiomyoma ◽  
Inferior Vena ◽  
Mechanical Thrombectomy ◽  
Vena Cava ◽  
Iliac Vein ◽  
Young Female ◽  
Common Iliac Vein ◽  
Venous Obstruction ◽  
Recurrent Thrombosis ◽  
Phlegmasia Cerulea Dolens

Abstract This case is of a young female with a large uterine leiomyoma causing phlegmasia cerulea dolens with thrombosis of the left common and left external iliac veins. She underwent mechanical thrombectomy to temporize the condition until she could be evaluated by gynecology-oncologist to remove the cause of venous obstruction. Prior to hysterectomy, suprarenal inferior vena cava filter was placed. Less than 12 hours post hysterectomy she developed recurrent thrombosis involving the left common and external iliac veins. She underwent repeat mechanical thrombectomy with wall stent placement in the left common iliac vein with resolution of her symptoms.

Sign in / Sign up

Export Citation Format

Share Document