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Age: 32

Sex: Male

Indication: Left leg swelling

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Case #42


Findings

  • Echogenic material filling the lumens of the common and profunda femoral veins, which are noncompressible and demonstrate no substantial internal flow on Doppler analysis
  • The distal deep veins in the left lower extremity remain patent, but lack typical respiratory variation in flow
  • Echogenic material extends proximally into the left external and common iliac veins, which are incompletely assessed on this study


Diagnosis

  • Deep venous thrombosis
  • May-Thurner syndrome

Sample Report

Occlusive deep venous thrombosis of the left common and profunda femoral veins extending proximally into the left external and common iliac veins, incompletely assessed on this study. This configuration is suggestive of May-Thurner syndrome and can be further assessed with contrast-enhanced CT of the abdomen and pelvis.


Discussion

  • Think of May-Thurner syndrome when you see left lower extremity deep venous thrombosis (DVT) extending proximally to involve the iliac veins, especially in a patient without known risk factors or precipitating event for DVT
  • May-Thurner syndrome results from compression of the left common iliac vein proximally between the right common iliac artery and the spine, which impairs venous drainage and can lead to in situ thrombosis
  • CT is often obtained to better assess proximal extension of thrombus and for surgical planning (if surgery is indicated)
  • Notice in this case how an occlusive proximal thrombus can result in lack of respiratory variation in patent distal veins


Images

May-Thurner syndrome results from compression of the left common iliac vein (red arrow) between the right common iliac artery (yellow arrow) and the spine.

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