Diagnosis of May-Thurner Syndrome in a Case of Acute Pulmonary Embolism with Multiple Risk Factors: A Case Report and Review of Literature

Abstract

Background: May-Thurner Syndrome (MTS) is aniliac vein compression syndrome which results in a thrombosis of the common left iliac vein. The main cause of this compression is the overlying right common iliac artery. Method: In this article we describe the case of a 35-year-old woman with bilateral lobar pulmonary embolism (PE) together with an investigation of the risk factors leading to PE. The final diagnosis was a MTS with asymptomatic left internal vein thrombosis, further complicated by a PE. Results: Precipitating factors were polycystic ovarian syndrome, combined oral contraceptives and a possible protein S deficiency.Treatment encompassed anticoagulation during the first year of treatment. Re-evaluation together with further retesting of protein S and imaging will determine the need for an endovascular approach to the iliac vein compression. In this article we discuss the diagnostic approach to patients with PE with an asymptomatic deep venous thrombosis. Conclusions: This article seeks to draw attention to MTS as an incompletely studied syndrome which is potentially frequent in female patients with PE and interacts with other factors to increase the risk of a thrombosis. MTS should be considered in the differential diagnosis of a patient with PE in addition to patients presenting with a proximal deep venous thrombosis.