Abstract
May-Thurner Syndrome, left iliac vein compression by the right iliac artery, is a congenital permissive lesion that requires an additional insult prior to the onset of symptoms. We present a case of a 31-year-old gravida 1 para 0 at 28.6 weeks who presented to the emergency room with a 2-month history of progressive lower left leg swelling since 21.2 weeks’ gestation. The patient endorsed incidence of domestic violence at 17 weeks’ gestation. The patient had a twin sister who was also pregnant and had not experienced these symptoms. Physical exam revealed 3+ pitting edema in the left lower extremity from ankle to groin. There was left calf tenderness with negative Homan’s sign bilaterally. Overall finding on magnetic resonance angiography revealed severe compression of the upper left common iliac vein and lower inferior vena cava by gravid uterus. Conservative management and anticoagulation is instrumental in preventing veno-thromboembolic events in pregnancies complicated by MTS.
Highlights
First described by May and Thurner in 1957, May-Thurner Syndrome is described as left iliac vein compression by the right common iliac artery, which can lead to increased risk of deep vein thrombosis or lymphedema [1]
The primary objective of this study is to describe a case of May-Thurner syndrome (MTS) in a population where a gravid uterus can often exacerbate the compression of the iliac vein, causing it to be the initial time a patient is diagnosed with the disease
We present a novel case of May-Thurner syndrome (MTS) in a pregnant female without evidence of a DVT or previously identified risk factors
Summary
First described by May and Thurner in 1957, May-Thurner Syndrome is described as left iliac vein compression by the right common iliac artery, which can lead to increased risk of deep vein thrombosis or lymphedema [1]. We present a case of a 31-year-old woman presenting at 28 weeks’ gestation with progressive history of lower left leg edema since 21 weeks’ gestation. A 31-year-old G1P0 at 28.6 weeks presented to the ED with a 2-month history of progressive lower left extremity (LLE) swelling since 21.2 weeks’ gestation. The patient had no history of DVT, pulmonary embolism, thrombophilia, or past history of leg swelling. Right extremity exhibited no edema, with thigh 22 1⁄2 inches and calf 16 1⁄2 inches. There was left calf tenderness with negative Homan’s sign bilaterally. The initial workup included an outpatient venous Doppler ultrasound of bilateral lower extremities, which revealed no identified DVT. One additional outpatient Doppler ultrasound was obtained due to increasing swelling and was negative. A third Doppler ultrasound was obtained in the ED and was negative for DVT.
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