Right Sided May Thurner Does Exist
Joann Lohr1, Tim Brennan, MD2, Anil Verma, MD2.
1Lohr Surgical Specialists, Cincinnati, OH, USA, 2Mercy Health, Cincinnati, OH, USA.
DEMOGRAPHICS: May Thurner Syndrome well known anatomic anomaly where left common iliac vein is compressed between the right common iliac artery and the fifth vertebral body. Case reports exist describing “Right sided” May Thurner syndrome where the right common iliac vein is compressed by the left common iliac artery in a patient with left sided vena cava. CT scan has incidentally identified more anatomic variants.
HISTORY: Case presentation spontaneous right iliofemoral DVT associated with gastrointestinal issues.
PLAN: A twenty one year old female was admitted with diarrhea and dehydration. She was diagnosed with a Salmonella infection acquired from a pet lizard. She had elevated liver enzymes as well. She as discharged home but returned to the Emergency Room with phlegmasia of the right lower extremity. Her symptoms were so severe a CTA was performed due to decreased/absent pulses. She had extensive iliofemoral DVT in the right lower extremity and pulmonary emboli. She was treated with mechanical pharmacologics which revealed an underlying iliac vein compression. She subsequently had venous study done which revealed all compressive findings. She remains on anticoagulants.
DISCUSSION: All patients with extensive proximal DVT should be evaluated for treatable causes of obstruction even if the right side is involved.
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