A rare case of May-Thurner-like syndrome in an elderly lady

Abstract

An elderly lady presented with decreased mobility, sputum production and intermittent confusion. She was treated for chest sepsis, fast atrial fibrillation, and acute kidney injury, and also noted to have a swollen left leg. Venous duplex imaging showed extensive thrombus within the left common iliac, left external iliac and left common femoral veins. A CT Venogram showed compression of the left common iliac vein between an osteophyte at L5 and a calcified ipsilateral common iliac artery. It also showed a pelvic kidney with an extra renal pelvis and large renal cyst which was indirectly contributing to venous compression by splinting the left iliac artery. A decision was made after discussion at the Vascular MDT that the patient was not fit enough for surgery and to manage her medically with anticoagulation. Discussion: Proximal DVT’s are rarer than distal thrombosis, but have similar causes. One of the rarer causes of proximal DVT is May-Thurner syndrome and its variants known collectively as non-thrombotic iliac vein lesions. May-Thurner originally described DVT formation caused by extrinsic compression of the left common iliac vein between the overriding contralateral (right) common iliac artery and adjacent lumbar vertebrae. The best imaging modality is a CT Venogram. Duplex ultrasonography can be used, although it can be difficult to visualize the iliac veins. The mainstay of management is surgical thrombectomy, or thrombolysis, followed by stenting of the affected vessel. However, if intervention is not appropriate, then it can be managed medically with anticoagulation.