Abdominal Cyst Research Articles

Abdominal Cystic Echinococcosis Treated with Albendazole. A Pediatric Cohort Study.

IntroductionCystic echinococcosis is endemic in Argentina. The standard pharmacological treatment for the disease is albendazole, but surgery is a common alternative. Even though primary infection occurs mainly in the pediatric population, the optimal therapeutic option in pediatrics is not clearly defined and few pediatric cohorts with cystic echinococcosis treated with albendazole have been described to date.ObjectiveTo describe therapeutic response to albendazole in a cohort of pediatric patients with abdominal cystic echinococcosis.Population and MethodsPatients (0–18 years old) with abdominal cystic echinococcosis who were treated with albendazole between January 1998 and August 2013. Diagnosis of abdominal cystic echinococcosis was made by ultrasound. All patients received albendazole, 10–15 mg/kg/day. Epidemiological data, symptoms, number, location and outcome of the cysts, serology and treatment received were analyzed. The parameter used to assess treatment response was cyst changes evaluated by ultrasound follow up using the WHO-IWGE classification.ResultsA total of 28 patients (with 46 abdominal cysts) were included in the cohort. Mean age at enrolment was 9.4 years and mean duration of follow-up, 23.8 months. All patients resided in rural areas and had had contact with dogs. The asymptomatic form of the disease was the most common presentation. All patients received albendazole (mean duration: 142.5 days), with low incidence of adverse events. Albendazole had a positive effect on most of the cysts. Surgery was performed in 13 patients.ConclusionTreatment with albendazole for uncomplicated cystic echinococcosis cysts is safe and effective, and can potentially reduce the need for surgical intervention.

A Rare Presentation of an Abdominal Lymphoepithelial Cyst with New Roots

A Rare Presentation of an Abdominal Lymphoepithelial Cyst with New Roots

Laparoscopic distal pancreatosplenectomy for a large MCN with left portal hypertension

Aims: To demonstrate an operative video of a radical laparoscopic distal pancreatosplenectomy for a huge MCN with left portal hypertension in a young woman. Methods: A 35-year old woman presented with non specific upper abdominal pain, predominantly on the left. All relevant blood investigations were normal. An ultrasound scan detected a large upper left abdominal cyst over 15 cm in diameter. She then had a CT scan which suggested a large distal pancreatic cyst, extending to the spleen measuring 20 × 20 cm with no internal septations. The spleen was enlarged at 17 cm and the splenic vein was compressed. In preparation for surgery, she underwent an EUS to confirm the nature and content of the cyst. The fluid was confirmed to be mucinous and the aspirate was acellular. A laparoscopic distal pancreatosplenectomy was planned. Results: Surgery was undertaken in a supine partial lithotomy position with the surgeon standing between the legs. Four ports (12, 12, 5 and 5 mm) were used. An antegrade radical distal pancreatosplenectomy was performed. Intraoperatively, as expected, the patient was found to have significant left-sided portal hypertension due to compression of the splenic vein by the cyst. The procedure was completed laparoscopically in 95 minutes. The intraoperative blood loss was 350 ml. The patient developed a grade-A pancreatic fistula (as defined by ISGPF) for one day. She was discharged after drain removal on the fifth postoperative day with no other significant postoperative complications. Conclusions: It is feasable and safe to perform a laparoscopic distal pancreatosplenectomy for very large pancreatic cysts in presence of significant portal hypertension with minimal comorbidity and short postoperative stay.

Primary Umbilical Hydatyid Cyst: A Case Report

Hydatid disease is endemic in Middle Eastern countries. Liver is the most involved organ, followed by the lung. We review a case of abdominal wall hydatid cyst in a 75 years old lady that was presented with bulging and redness of umbilicus mimiking umbilical hernia. After opening the abdominal wall hydatid cyst was diagnosed and removed and after irrigation with silver nitrate the abdominal wall was closed . And in one year follow up no recurrence has been detected.

Meconium peritonitis: A rare neonatal surgical emergency.

Sir, We present two cases of meconium peritonitis, a rare neonatal surgical emergency. The first baby, 1.8 Kg in weight, born at 32 weeks gestation had Apgar score of 8/10 at 1 min, heart rate (HR) was 164/min, respiratory rate (RR) 54/min and capillary refill time (CRT) 3 s. Abdomen was distended with a hard palpable lump in the supra-umbilical region. There was respiratory distress with intermittent apnoeic episodes for which the baby was intubated. Ultrasonography at 29 weeks showed ascites, bilateral pleural effusion, calcification along the liver surface and an abdominal lump. Abdominal radiograph revealed a centrally located large calcific lesion [Figure 1]. Haemoglobin was 19.2 g %, leucocyte count 17,700/mm3, C-reactive protein (CRP) 192 mg/L (normal <10 mg/L), creatinine 1.3 mg% and electrolytes and blood gases were normal. Diagnosis of meconium peritonitis was made and baby was posted for emergency laparotomy on day 1 of life. Anaesthesia was induced with sevoflurane in oxygen (O2) and maintained on sevoflurane, O2, air (50:50) with fentanyl 2 μg/kg for analgesia. Peripherally inserted central catheter (PICC) (1 Fr G) was inserted through the right cephalic vein. There was an episode of hypotension where blood pressure fell to 42/20 mm Hg for which fluid bolus was given and dopamine infusion started at 10 μg/kg/min. The large calcific deposit was removed, meconium was aspirated and suture of ileal perforation was done. Baby was electively ventilated and extubated on the 4th post-operative day. Figure 1 Chest and abdominal radiograph showing intra-abdominal calcification in the central location The second baby weighing 2 kg was delivered at term by caesarean section. Apgar score was 9/10 at 1 min, HR: 142/min, RR: 48/min and CRT < 3 s. Abdomen was distended. Ultrasound revealed dilated bowel loops with echogenic contents and free fluid suggestive of meconium peritonitis. Haematological investigations were normal. Baby was posted for emergency laparotomy on day 1 of life. Anaesthesia was induced with sevoflurane in O2. Rocuronium 1.2 mg/kg was administered and modified rapid sequence induction was performed with cricoid pressure and gentle ventilation. Exactly 45 s later airway was secured with 3.5 mm ID endotracheal tube. Anaesthesia was maintained on sevoflurane at 1.2 MAC, air, O2 mixture (50:50) and fentanyl 2 μg/kg. Adhesiolysis with excision of meconium pseudocyst in jejunum was performed. PICC (1 Fr G) was inserted through left great saphenous vein. Trachea was extubated on table. Meconium peritonitis is an aseptic chemical peritonitis which results from perforation of the gut in utero.[1] Incidence is 1 in 35,000 live births.[2] Possible causes include mesenteric ischaemia, volvulus, intestinal atresia, meconium plugs, internal hernia and Hirschsprung's disease.[3] Other associations include chromosomal aberrations and cystic fibrosis. Perforation of the intestines in utero results in leakage of meconium into the peritoneal cavity. Inflammatory reaction and chemical peritonitis occurs, which subsequently seals forming intra-abdominal calcifications. Huge abdominal cyst formation and ascites may develop which can cause foetal cardiac insufficiency and cardiorespiratory compromise after birth.[3] Prenatal ultrasound is diagnostic.[4] Management begins at delivery. Fluid resuscitation may be needed if the baby is in shock. Bag-mask ventilation may further aggravate bowel distension. Endotracheal intubation with controlled ventilation is preferable. Initial stabilisation of cardiopulmonary parameters and blood gas analysis, CRP, lactates, haematocrit, blood count, platelets, electrolytes, culture and cross match are done. Inotropes are started early if haemodynamic instability does not respond to fluid boluses. Chest and abdominal radiographs, ultrasound of abdomen and echocardiography are preferable as persistent pulmonary hypertension may complicate the management. These babies are then managed in a staged approach. An abdominal drainage with ultrasound guidance under local anaesthesia is preferred in critical neonates. Exploratory laparotomy with adhesiolysis and enterostomy is done in haemodynamically stable babies. Finally, stoma closure is performed. Prolonged antibiotic administration postoperatively and enteral nutrition may warrant PICC insertion. Complications such as wound infection, intestinal fistula, abdominal abscess, cerebral haemorrhage due to disseminated intra-vascular coagulation, sepsis and multi-organ failure may occur.[3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Experience with Extra Hepatic Intra Abdominal Hydatid Cyst

Hydatid disease is a significant health problem with their location at Extrahepatic Intra abdominal sites is a very rare disease. Disease in these sites usually found concurrently with liver hydatid disease. Diagnosis is based blood tests & imaging studies. Surgery is the mainstay of treatment. This study will help us in determining the frequency of Extra Hepatic Intra Abdominal Hydatid Disease. Also different methods to diagnose & treat the disease will be evaluated. It includes patients of extra hepatic intra abdominal Hydatid cyst above 13 years and underwent surgery from 2009 to 2014. Variables include age, sex, clinical findings, diagnostic investigations, operative findings, operative procedure, post operative complications. Eleven patients; 07 male & 04 female; mean age 37.54 years. Most common symptoms were mass in abdomen in 11 patients & dull pain abdomen in 09 (81.8%) patients. Examination revealed non tender mass in epigastric & umbilical region in 04 (36.3%) patients. Ultrasound Abdomen showed hydatid cyst spleen in 02 (18.1%) patients, epigastrium in 04 (36.3%) patients, beneath left crus of diaphragm in 02 (18.1%) patients & right iliac fossa & pelvis in 1 (9.09%) patient. In 02 (18.1%) patients multiple Hydatid cysts were noted. Hydatid cysts liver found in 07 (63.6%) patients. C.T scan Abdomen was performed in 09 (81.8%) patients. Surgical procedures performed include Saucerization & omental packing in liver Hydatid cysts; Splenectomy for Splenic disease & complete excision of remaining intra-abdominal Hydatid cysts. Postoperative complications noted in 05 (45.4%) patients. Extra hepatic intra abdominal is an infrequent disease presents significant diagnostic & therapeutic challenge for surgeons.

Benign cystic lymphangioma of sigmoid mesocolon presenting as abdominal catastrophe: an extremely rare entity

Mesenteric cystic lymphangiomas (MCLs) are uncommon benign cystic tumours of unknown aetiology, most often seen in paediatric patients. The clinical presentation ranges from an incidentally discovered abdominal cyst to symptoms of acute abdomen. A10-year-old male presented with generalized abdominal pain, nausea and vomiting &amp; constipation of several hours duration. Emergency laparotomy revealed multiple cystic masses along both the sides of sigmoid colon and mesocolon, which were inflammed mimicking diverticulosis. Sigmoidectomy with colorectal anastomosis was performed. The postoperative course was uncomplicated. MCLs should be included in the differential diagnosis of cystic intra-abdominal lesions. Even when asymptomatic and discovered incidentally, they must be treated surgically because of the potential to grow, invade vital structures and develop life-threatening complications. Health Renaissance 2014;12(2): pp: 130-132

Prenatal diagnosis of a giant choledochal cyst

Abstract A choledochal cyst is a rare and usually benign condition that is diagnosed in 80% of cases in early infancy. Prenatal diagnosis is increasingly identifying the cysts allowing an early surgical treatment with less risk of complications. We report a case of a newborn with prenatal diagnosis of a giant right upper quadrant abdominal cyst. During surgery, an 8 cm choledochal cyst was found. A cholecistectomy, surgical excision of the cyst and formation of a Roux-en-Y hepaticojejunostomy was performed.

Hydatid Disease Presented as Acute Abdomen, an Interesting Incidental Finding: A Case Report

Introduction: Hydatid disease can involve various body organs, but it is less common for it to involve multiple organs simultaneously. Hydatid cysts present unique manifestations in each organ. Some of these manifestations are rarely reported. In this report, we discuss a case of hydatid disease of the liver and omentum. Although most of the abdominal hydatid cysts are considered to be asymptomatic, our patient presented with symptoms of acute abdomen due to a torted peritoneal cyst, which is a very rare presentation. Case Presentation: A 40-year-old man was referred to the emergency department with dull and intermittent periumbilical pain in the left and right lower quadrant regions accompanied by moderate tenderness and rebound with involuntary guarding over the entire lower half of the abdomen. As the patient’s condition and abdominal pain were worsening rapidly, an open laparotomy was scheduled with the primary suspicion of peritonitis. During the surgery, five omental cysts were observed within different parts of the abdomen. One of the cysts was torted. Two simple cysts were also detected on post-operative abdominal computed tomography. Conclusions: It is important to keep in mind that even peritoneal involvement may be seen despite intact hepatic cysts. Careful excision of these cysts is the treatment of choice.

胎児期に腹腔内囊胞を指摘された低位鎖肛合併segmental dilatation of colonの1例

胎児期に腹腔内囊胞を指摘された低位鎖肛合併segmental dilatation of colonの1例

Hasi cysták és cystosus képletek differenciáldiagnózisa gyermekkorban

19 children were diagnosed with abdominal cysts of different origin in the Surgical Unit of the Department of Pediatrics, Medical University of Pécs, Hungary between 2010 and 2013. The authors discuss the details of representative cases of a parovarial cyst, an intestinal duplication, and an omental cyst with emphasis on the clinical symptoms, diagnostic tools, and surgical interventions. The authors conclude that abdominal cysts often cause mild symptoms only, and they are discovered accidentally by ultrasound imaging performed for other reasons. In some cases, the cyst can cause severe complaints or even acute abdomen requiring emergency surgery. Laporoscopy may be a valuable method both in diagnosis and surgical therapy. Abdominal CT or MRI are not required in the majority of the patients.

Peritoneal Dialysis can be an Option for Dominant Polycystic Kidney Disease: An Observational Study

Autosomal dominant polycystic kidney disease (ADPKD) has been considered a relative contraindication for peritoneal dialysis (PD), although there are few specific studies available. A multicenter historical prospective matched-cohort study was conducted to describe the outcome of ADPKD patients who have chosen PD. All ADPKD patients starting PD (n = 106) between January 2003 and December 2010 and a control group (2 consecutive patients without ADPKD) were studied. Mortality, PD-technique failure, peritonitis, abdominal wall leaks and cyst infections were compared. Patients with ADPKD had similar age but less comorbidity at PD inclusion: Charlson comorbidity index (CCI) 4.3 (standard deviation [SD] 1.6) vs 5.3 (SD 2.5) p < 0.001, diabetes mellitus 5.7% vs 29.2%, p < 0.001 and previous cardiovascular events 10.4% vs 27.8%, p < 0.001. No differences were observed in clinical events that required transient transfer to hemodialysis, nor in peritoneal leakage episodes or delivered dialysis dose. The cyst infection rate was low (0.09 episodes per patient-year) and cyst infections were not associated to peritonitis episodes. Overall technique survival was similar in both groups. Permanent transfer to hemodialysis because of surgery or peritoneal leakage was more frequent in ADPKD. More ADPKD patients were included in the transplant waiting list (69.8 vs 58%, p = 0.04) but mean time to transplantation was similar (2.08 [1.69 - 2.47] years). The mortality rate was lower (2.5 vs 7.6 deaths/100 patient-year, p = 0.02) and the median patient survival was longer in ADPKD patients (6.04 [5.39 - 6.69] vs 5.57 [4.95 - 6.18] years, p = 0.024). Peritoneal dialysis is a suitable renal replacement therapy option for ADPKD patients.

Prenatal consultation for foetal anomalies requiring surgery.

During prenatal screening of pregnant women, foetal anomalies requiring surgery may be diagnosed. Healthcare providers should have a basic knowledge of these diseases, including their workup, comorbidities, prognosis, treatment options and any considerations that need to be made in planning for birth. This article aims to provide this information by summarising the most recent literature for some of the most commonly diagnosed foetal anomalies requiring surgical correction. English language studies on prenatal diagnostic modalities, abdominal wall defects, congenital diaphragmatic hernias, surgical conditions leading to airway compromise, hydrops fetalis, intestinal obstruction and abdominal cysts were retrieved from the PubMed database. The most recent and relevant literature is summarised regarding the above listed paediatric conditions. The incidence and prevalence (when available), prognosis, workup, common comorbidities, foetal interventions and special birth considerations (when applicable), and postnatal surgical treatment options are reviewed. Healthcare providers will occasionally encounter foetal anomalies which may require surgery while performing prenatal screening. They may need to provide early counselling to expectant parents to inform their expectations. When indicated, referrals should be made to a foetal care centre for prenatal consultation. For conditions which may cause danger or distress to the foetus in the immediate postnatal period, preparations should be made to ensure sufficient resources are available at the location of birth.

Images kystiques abdominales fœtales du premier trimestre

ObjectivesAbdominal cysts are seldom detected at the first trimester scan. The aim of this study is to ascertain their outcome, which is currently not established. MethodsThe French College of Fetal Ultrasound conducted a prospective observational study of 24months, collecting all cases of abdominal cysts discovered during the first trimester ultrasound. Cases of megacystis were excluded from the study. Ultrasound images, prenatal diagnosis expert reports and pregnancy outcomes were collected by sonographers after patient consent. ResultsTen cases of abdominal cysts were collected. The cysts had a mean diameter of 15mm. They were anechoic in 5 cases, hyperechoic in 2 cases and mixed in 3 cases. In 6 of 10 cases, complete resolution was observed at 18WG with a good post-natal outcome; the five cases with anechoic images were associated with normal pediatric examination at birth and in the case of the resolved hyperechoic image, an isolated imperforate anus was observed. In the four cases of hyperechoic or mixed images that had not resolved, the outcome was poor with four termination of pregnancies, including two cases of cloacal dysgenesis. ConclusionsAbdominal cysts are rare at the first trimester scan. They resolve in two thirds of cases and are then associated with good outcome. When they do not resolve or when they are not strictly anechoic, they require a referral ultrasound examination at 18 and 22WG.

Fetal ovarian cysts: review of imaging spectrum, differential diagnosis, management, and outcome.

Fetal ovarian cysts are the most common abdominal cysts observed in the female fetus but may be mistaken for genitourinary cysts, gastrointestinal cysts, lymphangiomas, or fetus in fetu. Ultrasonography (US) is the imaging modality of choice for fetal assessment, and magnetic resonance imaging is a useful problem-solving tool when uncertainty remains after careful US evaluation. At US, a fetal ovarian cyst manifests as an anechoic thin-walled cyst superior and parasagittal to the bladder. A daughter cyst may occasionally be observed and is pathognomonic for a cyst of ovarian origin. Fetal ovarian cysts may be simple or complicated and unilateral or bilateral, and they may masquerade as a solid mass when hemorrhage or torsion occurs. Complicated cysts may exhibit multiple septations, fluid-fluid levels, or mobile internal echoes. It is important to differentiate a hemorrhagic ovarian cyst from solid abdominal neoplasms that may be seen in a fetus. Recognition of the pertinent imaging findings will help radiologists distinguish fetal ovarian cysts from other fetal intra-abdominal masses in the differential diagnosis. Malignant ovarian neoplasms are rare in the fetus and neonate and thus are not considered in the differential diagnosis. The current literature on the management and outcome of fetal ovarian cysts is reviewed, with imaging studies presented from the authors' practice. Most fetal ovarian cysts resolve spontaneously; if operative intervention is required, the goal should be ovarian preservation.

Symptomatic abdominal simple cysts: is percutaneous sclerotherapy with hypertonic saline and bleomycin a treatment option?

Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts.

Fetal Midgut Volvulus with a Cystic Appearance, Accompanying a Sinus Rhythm and an Increased Peak Systolic Velocity without Anemia.

A midgut volvulus rarely occurs in a fetus; however, when it does, it requires an immediate diagnosis and surgery. Thirty-week pregnant was referred to our clinic with a diagnosis of a fetal abdominal cystic mass and preterm labor. The initial ultrasound examination revealed a female fetus with a 55 × 50 mm cystic mass in the lower abdomen, which was preliminarily diagnosed as an ovarian cyst. There was a sinusoidal rhythm on cardiography. The middle cerebral artery peak systolic velocity was 60.4 cm/sec, compatible with 1.49 MoMs that suggested fetal anemia on Doppler examination. Uterine contractions were observed with tocography and maternal hydration was administered for tocolytic treatment. Despite hydration, uterine contractions continued and the infant was delivered. A newborn ultrasonographic evaluation revealed a 6 cm abdominal cyst, and plain abdominal radiographs revealed distended loops of the small bowel on the left side. Emergency surgery was performed. A midgut volvulus leading to dilatation and necrosis of the small bowel without anatomical causes was observed during laparotomy. The necrotic bowel loop was resected and an end-to-end anastomosis was performed. The newborn died due to multiorgan failure. Obstetricians should be familiar with the appropriate diagnosis and management of a fetal volvulus.

A Rare Case of Intra- Abdominal Bronchogenic Cyst- A Case Report

Bronchogenic cysts are developmental foregut anomalies usually located in the mediastinum. A 90% of the bronchogenic cysts occur in the posterior aspect of superior mediastinum. Retroperitoneal location of a bronchogenic cyst is rare. We report a rare case of intra abdominal bronchogenic cyst. A CT scan was done for a 34-year-old female who presented with complains of heaviness in the right flank. CT scan revealed a large cyst of 10 x 6 cm in the right hypochondrium. Cyst was removed laparoscopically and the histopathology revealed a bronchogenic cyst.

Fetal Abdominal Cysts: Prenatal Diagnosis and Management

Objective: Fetal intra-abdominal cystic masses are quite rare entities and their differential diagnosis is particularly perplexing. These masses encompass many different pathological cysts originating from almost every organ in the abdomen. In female fetuses, ovarian cysts are the primary cause. In our study, we investigated the techniques used in diagnosis, accuracy of methods and management strategies, and tried to summarize postnatal outcomes. Materials and methods: A total of 29 cases were evaluated retrospectively by reviewing their ultrasonography (USG) results, magnetic resonance imaging (MRI) scans, interventions in perinatal period, postnatal follow up and surgical outcomes. Results: Twenty nine (25 female 4 male) cases were included in the study. Mean gestational week at diagnosis was 30,0 ± 6,4 for ovarian cysts and 24,7 ± 7,5 for non-ovarian cysts. Mean diameter of cysts was 41,7 ± 25,4 mm. 17 cysts (56%) were of ovarian origin, 6 (20,7%) were mesenteric cysts, 3 of them (10.3%) originated from kidneys and 3 (10.3%) of the cysts turned out to be choledochal-subhepatic cysts. In postnatal period, 8 cases required surgery which was ovarian and mesenteric cysts. In two incidences, gonads had to be removed. In differential diagnosis of masses, diagnostic accuracy of USG was calculated as 72,4% while that of MRI was 87.5%. Conclusion: Fetal abdominal cysts are seen more frequently in female fetuses and recognized relatively later during the pregnancy. Aspiration of the cysts in masses with larger diameters may be useful in reducing frequency of complications leading to gonad losses. Most common non-ovarian cysts are mesenteric cysts which also cause complications and require surgical interventions. Both USG and MRI are highly accurate imaging techniques in cases with adnexial masses. They have roughly the same accuracy in differential diagnosis of fetal abdominal cystic lesions.

A case report of May–Thurner Syndrome associated with a large intra abdominal cyst

Introduction: May–Thurner Syndrome (MTS) usually presents with signs and symptoms of deep vein thrombosis or chronic venous insufficiency. We report the first case of MTS in a previously healthy adolescent female associated with a large intra-abdominal cyst arising from the right ovary. Case Report: The patient presented with signs and symptoms suggestive of deep vein thrombosis. Imaging confirmed extensive deep vein thromboses extending into the common iliac vein. Further imaging successfully diagnosed MTS and also identified a cyst arising from the right ovary. Catheter-directed thrombolysis followed by removal of the cyst and the right ovary was performed. Following re-thromboses few days later, the patient underwent further management with surgical thrombectomy with left common iliac vein stenting and IVC filter placement. Conclusion: The present case identifies an unusual presentation of a previously undiagnosed MTS in an adolescent female. In this case, anticoagulation alone was found to be ineffective and required the assistance of endovascular intervention.