Abstract
May-Thurner syndrome, which has been called by many names, including Cockett syndrome, iliocaval compression syndrome, and iliac vein compression syndrome, is an anatomic variation where there is extrinsic venous compression by the arterial system against the bony structure of the axial skeleton, most commonly right common iliac artery compressing the left iliac vein against the fifth lumbar vertebra. The persistent right common iliac pulsation results in endothelial irritation of the venous system and at the same time reduces venous return, hence satisfying two factors in Virchow's triad for the formation of venous thrombosis. Here we present a rare case of a patient who presented with multiple risk factors that could propagate the formation of deep vein thrombosis with the underlying anatomic variation of May-Thurner syndrome in the setting of dehydration, systemic infection, failure to thrive, and psychiatric decompensation. Treatment required fluid hydration, antibiotic therapy, and mechanical thrombectomy in conjunction with local infusion of thrombolytics. Subsequent stent placement was performed to prevent re-thrombosis and stenosis of the affected area with long-term oral anticoagulation.
Highlights
The exact incidence and prevalence of May-Thurner syndrome continues to be controversial and is stated to be underestimated [1,2]
May-Thurner syndrome, which has been called by many names, including Cockett syndrome, iliocaval compression syndrome, and iliac vein compression syndrome, is an anatomic variation where there is extrinsic venous compression by the arterial system against the bony structure of the axial skeleton, most commonly right common iliac artery compressing the left iliac vein against the fifth lumbar vertebra
We present a rare case of a patient who presented with multiple risk factors that could propagate the formation of deep vein thrombosis with the underlying anatomic variation of MayThurner syndrome in the setting of dehydration, systemic infection, failure to thrive, and psychiatric decompensation
Summary
The exact incidence and prevalence of May-Thurner syndrome continues to be controversial and is stated to be underestimated [1,2]. Hemoglobin Mean corpuscular volume Platelets White blood cell Neutrophils Neutrophils (relative percent) Bands Bands (relative percent) Lymphocytes Lymphocytes (relative percent) Monocytes Monocytes (relative percent) Glucose Blood urea nitrogen Creatinine Sodium Potassium Chloride Bicarbonate Anion gap Serum osmolality Activated partial thromboplastin time Prothrombin time International normalization ratio. Left lower extremity ultrasound revealed extensive near occlusive thrombus extending from the popliteal vein up the common femoral vein evidenced by a near absence of blood flow on the color Doppler study (Figure 1). She was aggressively hydrated, and antibiotic coverage was achieved with cefepime. The patient was subsequently transferred to the behavioral health unit and with an improvement of affect and mentation was discharged in a stable condition
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