A Case Report of May-Thurner Syndrome Identified on Abdominal Ultrasound

Ultrasound characteristics of abdominal vascular compression syndromes

Abdominal vascular compression syndrome (AVCS) is caused by the compression of abdominal blood vessels by adjacent structures or the compression of abdominal organs by neighboring blood vessels. Such compressions can result in a variety of clinical symptoms. They are not commonly seen in ultrasound practices, and their presence may have been underrecognized and underdiagnosed. This article reviews the clinical features, ultrasound characteristics, and diagnostic criteria of four types of AVCS, namely, celiac artery compression syndrome, renal vein compression syndrome, iliac vein compression syndrome, and superior mesenteric artery syndrome to increase awareness of these conditions among ultrasound practitioners. The ultrasound criteria for AVCS are primarily based on studies with small sample sizes, and therefore, it is important to exercise caution if these criteria are used.

A Case Report on May-Thurner Syndrome: Beyond the Usual Suspects

May-Thurner syndrome (MTS), also known as iliocaval venous compression syndrome, is a vascular condition characterized by extrinsic venous compression within the iliocaval territory. While traditionally considered a condition predominantly affecting women, this case report presents an atypical presentation in a middle-aged male patient. The patient initially presented with left lower extremity pain and swelling, which was attributed to deep venous thrombosis (DVT) in the left calf and femoral vein. Despite anticoagulation therapy, his symptoms persisted, leading to further diagnostic evaluation and the identification of MTS. This report highlights the clinical presentation, diagnostic challenges, and successful management of MTS in a male patient. Endovascular interventions, including balloon dilation and stent placement, were employed to address refractory stenosis and thrombus burden. The case emphasizes the importance of considering MTS as a potential diagnosis in patients with unexplained lower limb symptoms, irrespective of traditional risk factors or gender. Early identification and appropriate interventions can lead to symptom relief, obstruction resolution, and improved long-term outcomes for patients with MTS. This case underscores the need for heightened clinician awareness regarding MTS and its potential impact on patient care.

Pulmonary Embolism in an Adolescent With May-Thurner Syndrome: A Case Report

May-Thurner syndrome (MTS) is a pathological variant where the left iliac vein is compressed by the right iliac artery. Usually common in females between the third and fourth decades of life, this case report is about MTS in an adolescent girl. The patient was overweight and had a sedentary lifestyle. She developed a sudden onset of unilateral left leg deep venous thrombosis (DVT), leading to low-risk pulmonary embolism (PE) within a week of the symptoms starting. The patient received a heparin infusion for one week, after which she was switched to subcutaneous low-molecular-weight heparin. Apart from the initial high D-dimer, the rest of the thrombophilia workup was unremarkable. The whole exome sequencing (WES) study was negative. An inferior vena cava (IVC) filter was not advised for her due to the small size of the clot and her age. The patient responded well to heparin alone and was discharged home on enoxaparin.