Open AccessAcute bilateral pulmonary embolism in a 21-year-old: is May-Thurner syndrome in our differential?
Author(s) -
Rajarshi Bhadra,
Meyappan Somasundaram,
Daniel Iltchev,
Keyvan Ravakhah
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-227046
Subject(s) - medicine , may–thurner syndrome , deep vein , pulmonary embolism , thrombosis , differential diagnosis , surgery , radiology , emergency department , venous thrombosis , pathology , psychiatry
May-Thurner syndrome (MTS) is a clinical condition where the left common iliac vein gets compressed by the overlying right common iliac artery anterior to the fifth lumbar vertebra and the sacral promontory. It results in vessel wall injury and predisposition to thrombosis. We present a case of a 21-year-old African-American man with no significant past medical history who came to the emergency department with left lower limb swelling associated with shortness of breath, and was eventually diagnosed to have extensive left lower extremity deep vein thrombosis (DVT) along with acute bilateral extensive pulmonary embolism (PE) as a consequence to MTS. MTS should be considered in the differential when young patients present with unprovoked or recurrent left-sided DVT. Diagnosis of this anatomical variant is critical as it may need long-term anticoagulation and consideration of pharmaco-mechanical intervention such as mechanical thrombectomy and venoplasty with or without stenting.