A Case of May-Thurner Syndrome.

May-Thurner syndrome is the condition of the left common iliac vein being compressed between the right common iliac artery and the associated vertebral body. This condition has been linked to spontaneous episodes of deep vein thrombosis (DVT), especially in women aged 20-50, and it may contribute to the slightly higher tendency to develop left-sided (~56%) versus right-sided DVTs. A 50-year-old morbidly obese (BMI 42.7 kg/m2) female presented to the emergency room with acute left leg pain. Past medical history included asthma. Patient is employed as a helper in home health services; no recent history of travel and no history suggestive of hereditary thrombophilia. Prior tobacco use was noted. Patient was admitted to the medical floors and investigated for DVT. Ultrasound Doppler imaging of both legs demonstrated left-sided occlusive DVT in the popliteal, superficial femoral, common femoral veins with extension into the external iliac vein. Imaging in the right leg was unremarkable. Patient was treated with enoxaparin (Lovenox). A hypercoagulation panel was unremarkable. A left lower extremity venogram showed a thrombus at the level of the common femoral vein extending into the iliac vein with stasis of contrast within the right external iliac vein. Following that, she had venoplasty and thrombolytic therapy. The next day, she underwent left iliofemoral mechanical thrombectomy, venoplasty, and left common iliac vein stenting. After an uneventful recovery, the patient was discharged on rivaroxaban for 3 months. In summary, while this patient was initially thought to have unprovoked DVT, absence of any hypercoagulable disorders and the findings in venogram favored the diagnosis of May-Thurner syndrome. For women in this age group with this type of presentation, this is an important diagnosis to keep in mind.