LEFT LEG SWELLING: A CASE OF MAY-THURNER SYNDROME
Sangya Sharma - Edward Via College of Osteopathic Medicine, Blacksburg, Virginia
Correspondence to: Brian Monaco, MD Internal Medicine Willis Knighton Health System Shreveport, LA-71103 Email: Bmonacomdim@gmail.com Phone: (318) 629-3099
Brian Monanco, MD - Department of Internal Medicine, Willis Knighton Health System
ABSTRACT May-Thurner Syndrome is a left common iliac vein thrombosis caused due to its compression by right common iliac artery, an anatomical variant that is underreported. We report the case of a 52 year old female who presented with left leg swelling and was diagnosed with May-Thurner Syndrome. She underwent an iliac vein thrombectomy and was discharged on life- long anticoagulants.
normal except mild tenderness of left leg without erythema. Venous duplex ultrasound of the left leg revealed deep vein thrombosis extending to proximal left common femoral vein. CT scan of the abdomen and pelvis with IV contrast ( Figure 1 ) also confirmed deep vein thrombosis involving the left common iliac vein. There was compression of left iliac vein by right common iliac artery. This finding was described with May- Thurner Syndrome, or Iliac Vein Compression syndrome, which likely contributed to the patient’s left leg deep vein thrombosis. The patient had elevated D-dimer levels and factor VIII activity assay. She was started on enoxaparin 30 mg subcutaneously every 12 hours. She underwent a balloon thrombectomy ( Figure 2 ) with stent placement and had subsequent resolution of swelling in the affected leg. The patient was discharged with plans to continue life long Apixaban 5 mg BID to prevent future recurrence.
Keywords: May-Thurner, deep vein thrombosis, right common iliac artery, left common iliac vein, Apixaban
Abbreviations: MTS (May-Thurner Syndrome)
CASE PRESENTATION A 52 year old presented with complaints of left leg pain and swelling of four days duration. The examination findings were
RCIA LCIV LCIA
Figure 1. Axial image of chest computed tomography of abdomen and pelvis with IV contrast. Figure shows compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA). LCIA is the left common iliac artery.
Figure 1. Axial image of chest computed tomography of abdomen and pelvis with IV contrast. Figure shows compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA). LCIA is the left common iliac artery.
26 J LA MED SOC | VOL 174 | FALL 2022
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