May-Thurner Syndrome With Pulmonary Embolism as the First Presentation Rather Than Deep Vein Thrombosis

Fasanya, Adebayo; LaCapra, Gina

doi:10.7759/cureus.509

Cited by 8 publications

(11 citation statements)

References 9 publications

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“…We report an interesting case of MTS presenting as bilateral PE and left-sided DVT. Although cases of DVT have been frequently associated with this syndrome in the past, only a few cases have presented with acute bilateral pulmonary emboli 4–6…”

Section: Discussionmentioning

confidence: 99%

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

Bhadra¹,

Somasundaram

Iltchev

et al. 2019

BMJ Case Rep

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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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Section: Discussionmentioning

confidence: 99%

“…This vascular variant should be considered with high suspicion in left lower extremity DVT in young patients with no other aetiology to justify thrombosis. Prolonged anticoagulation, thrombectomy or stent placement for the relief of mechanical obstruction have been used in various clinical settings 6…”

Section: Discussionmentioning

confidence: 99%

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

Bhadra¹,

Somasundaram

Iltchev

et al. 2019

BMJ Case Rep

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“…IVCS, eponymously known as May–Thurner syndrome or Cockett–Thomas syndrome was previously thought to be a diagnosis that clustered in young women and a rare cause of lower extremity DVT . However, May and Thurner, in their original autopsy study described its presence in one‐fifth of all cadavers . With increasingly sensitive techniques like IVUS to identify iliac compression, diagnoses are made more frequently and in a more diverse cohort of patients, yet the finding's correlation with clinical VTE is not well established .…”

Section: Discussionmentioning

confidence: 99%

“…1 However, May and Thurner, in their original autopsy study described its presence in one-fifth of all cadavers. 8 With increasingly sensitive techniques like IVUS to identify iliac compression, diagnoses are made more frequently and in a more diverse cohort of patients, yet the finding's correlation with clinical VTE is not well established. 9 One case-control study of 230 patients demonstrated only a signal for increased left-sided DVT when the degree of stenosis exceeded 70% of vessel diameter on CT venography.…”

Section: Ivcs Eponymously Known As May-thurner Syndrome Ormentioning

confidence: 99%

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Brener

Parikh

Sethi

2019

Cathet Cardio Intervent

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We describe the case of a 72‐year‐old gentleman who was referred to our institution for management of cardiogenic shock from a massive pulmonary embolism. Right heart catheterization revealed a low cardiac index and markedly elevated pulmonary pressures, suggested long‐standing venous thromboembolic (VTE) disease that evolved into chronic thromboembolic pulmonary hypertension (CTEPH). The patient was cannulated to veno‐arterial extra‐corporeal membrane oxygenation and eventually treated with pulmonary embolectomy and thromboendarterectomy. Subsequently discovered inferior vena cava clot and left iliac deep vein thrombosis were treated with suction and mechanical thrombectomy. Intravascular ultrasound of the left lower extremity venous system identified iliac vein compression syndrome (IVCS) as the culprit of the patient's VTE and CTEPH. A left iliac stent was placed and the patient was discharged on Warfarin for anticoagulation. The case illustrates the rapidly expanding armamentarium for VTE treatment and proposes IVCS as a new, potentially underrecognized risk factor for CTEPH.

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“…Pulmonary embolism (PE) as the initial presentation is rare, but has been reported. 10 Patients with spontaneous iliac venous rupture and retroperitoneal hematoma need to be investigated with high suspicion as 28% have underlying MTS. 11 Symptoms might also include tingling and numbness in the lumbar area secondary to compression of the neural structures from the enlarged collaterals.…”

Section: Clinical Presentationmentioning

confidence: 99%

Evolving Concepts in the Diagnosis and Management of May–Thurner Syndrome

Chamarthy

Sutphin

Anderson

et al. 2017

J Clin Interv Radiol ISVIR

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May–Thurner syndrome is a common cause of left lower extremity venous thrombosis resulting from repetitive and dynamic compression of the left common iliac vein by the right common iliac artery, commonly seen in young to middle-aged women. The diagnosis requires high clinical suspicion. Computed tomography venography and magnetic resonance venography depict the extent of venous thrombosis and iliac venous compression in patients with underlying thrombotic and nonthrombotic pathologies, respectively. Contrast venography allows detection of acute and chronic thrombus, associated venous obstruction, and collaterals but is of limited value to evaluate the early venous wall abnormalities. Endovascular ultrasound is highly useful to detect early mural changes and accurately quantify venous narrowing. Endovascular intervention with balloon dilatation and stenting with or without pharmacomechanical thrombectomy followed by long-term anticoagulation is the preferred treatment with excellent technical and clinical outcomes. This review focuses on the current understanding of the pathology, clinical presentation, and endovascular management of May–Thurner syndrome.

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May-Thurner Syndrome With Pulmonary Embolism as the First Presentation Rather Than Deep Vein Thrombosis

Cited by 8 publications

References 9 publications

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

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

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Evolving Concepts in the Diagnosis and Management of May–Thurner Syndrome

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