SHM Converge Scientific Abstract ePoster Gallery-May-Thurner Syndrome - Atypical Presentation of an Underdiagnosed Pathology

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May-Thurner syndrome (MTS), also called iliac vein compression syndrome, is an underdiagnosed condition caused by compression of the left common iliac vein by the right common iliac artery. This compression leads to venous stasis, which can result in pelvic congestion, unilateral leg swelling, and deep vein thrombosis.<br /><br />The case describes a 36-year-old woman with chest pressure, shortness of breath, and bilateral leg swelling. She was initially evaluated for new-onset congestive heart failure because of an elevated NT-proBNP and symptoms of volume overload. However, cardiac testing was unrevealing: echocardiogram showed preserved ejection fraction without valvular or diastolic dysfunction, and cardiac MRI was negative for infiltrative disease. Doppler ultrasound excluded lower-extremity DVT. Further imaging with CT of the chest, abdomen, and pelvis revealed pleural effusions, pulmonary edema, hepatosplenomegaly, and importantly pelvic congestion with enlarged pelvic and ovarian veins. A CT venogram then demonstrated compression of the left common iliac vein by the right common iliac artery. Intravascular ultrasound confirmed the diagnosis of MTS.<br /><br />The patient was treated with endovascular stent placement of the left common and external iliac veins, resulting in marked improvement of the stenosis.<br /><br />This case highlights that MTS should be considered in younger women and in patients with unexplained leg edema or pelvic congestion, especially when cardiac workup is negative. Early recognition is important to prevent progression to DVT. Endovascular stenting is now a preferred treatment option and can be an effective alternative to open surgical repair.

Asset Subtitle

Raya Abbasi

Meta Tag

Author List Danielle Uibel, Darshan K. Patel, Raya Abbasi

Category Clinical Vignettes

Concept May-Thurner Syndrome

Concept Unilateral Lower Extremity Edema

Concept Deep Vein Thrombosis

Concept Intravascular Ultrasound

Concept Congestion

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Raya Abbasi

Track Adult

Keywords

May-Thurner syndrome

iliac vein compression syndrome

left common iliac vein

right common iliac artery

pelvic congestion

leg swelling

deep vein thrombosis

CT venogram

intravascular ultrasound

endovascular stenting

May-Thurner Syndrome

Unilateral Lower Extremity Edema

Deep Vein Thrombosis

Intravascular Ultrasound

Congestion