Abstract
Rationale:Contrast-enhanced computed tomographic venography (CTV) or magnetic resonance venography (MRV) are usually used to detect May-Thurner syndrome (MTS). However, both are associated with contrast-induced nephrotoxicity. For patients who cannot receive contrast media, non-contrast-enhanced MRV using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative. We report a case of MTS to describe its clinical utility and advantages.Patient concerns:A 49-year-old male experienced isolated left leg swelling and pain for half a month. He had a history of chronic renal insufficiency that made contrast-enhanced imaging studies inadequate.Diagnoses:A lower extremity venous Duplex scan showed a thrombus extending from the left distal femoral vein to the popliteal vein with valvular reflux, consistent with infrainguinal deep vein thrombosis (DVT). The suprainguinal DVT was evaluated by non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS.Interventions:The patient received angioplasty with the implantation of a balloon-expandable stent over the left common iliac vein.Outcomes:Excellent recanalization of the left iliac vein was noted postoperatively.Lessons:In the evaluation of suprainguinal venous lesions, non-contrast-enhanced MRV presents the venous structure alone at high resolution without the accompanying arterial structure, which makes it an excellent diagnostic imaging tool for MTS. These findings indicate that non-contrast-enhanced MRV could be useful for detecting systemic venous pathologies in patients with renal insufficiency.
Highlights
May-Thurner syndrome (MTS) is defined as an anatomic variant of right common iliac artery compression of the left common iliac vein with subsequent partial or complete impedance of the iliac vein outflow.[1]
The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with deep vein thrombosis (DVT) of the left common iliac vein caused by MTS
For patients suspected of MTS who cannot receive contrast media, non-contrast-enhanced magnetic resonance venography (MRV) using three-dimensional (3D) turbo spin-echo (TSE) is considered an alternative modality
Summary
May-Thurner syndrome (MTS) is defined as an anatomic variant of right common iliac artery compression of the left common iliac vein with subsequent partial or complete impedance of the iliac vein outflow.[1] When determination of the thrombus extent is necessary, contrast-enhanced computed tomographic venography (CTV), or magnetic resonance venography (MRV) may be used. We report a case of MTS with a comorbidity of chronic renal insufficiency and describe the clinical utility and advantages of non-contrast-enhanced MRV. The results showed sandwich external compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae, consistent with DVT of the left common iliac vein caused by MTS (Fig. 2). Venography with injection via the left common femoral vein showed a left common iliac vein obstruction with external compression (Fig. 3A-B). Written informed consent for publication from study participant was obtained for the study
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