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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Vascular
|SubCategory=Vascular
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Vascular
|SubCategory=Vascular
|Prompt=A 38-year-old female patient presents to the physician's office complaining of pain and swelling in her left leg. Upon further questioning, she informs the physician that she recently returned to the United States from a vacation in Europe. Upon physical examination, you observe that the patient experiences tenderness of her left calf with erythema and non-pitting edema, while the right leg appears normal.  Following appropriate work-up and imaging, the patient is diagnosed with May-Thurner syndrome.  Which of the following anatomic findings best characterizes May-Thurner syndrome?
|Prompt=A 38-year-old woman presents to the physician's office complaining of pain and swelling in her left leg. Upon further questioning, she informs the physician that she recently returned to the United States from a vacation in Europe. Physical examination is remarkable for erythema, non-pitting edema, and tenderness of the left calf. In contrast, the right leg appears normal.  Following appropriate work-up and imaging, the patient is diagnosed with May-Thurner syndrome.  Which of the following anatomic findings best characterizes May-Thurner syndrome?
|Explanation=
|Explanation=[[File:MTS.jpg|400px|CIA: Common iliac artery, CIV: Common iliac vein <BR> courtesy of radiopaedia.org]]
 
[[File:MTS.jpg|400px|CIA: Common iliac artery, CIV: Common iliac vein <BR> Courtery of radiopaedia.org]]
 
[[May-Thurner syndrome]] (MTS) is also called iliocaval compression syndrome because it is characterized by the compression of the left iliac vein by an overriding right iliac artery. Patients with [[May-Thurner syndrome|MTS]] are typically young female patients who present with symptoms consistent with deep vein thrombosis (DVT).
The DVT in [[MTS]] is more common on the left side than the right side because of the anatomic etiology of the disease that compresses the left venous side with impaired venous return on that side.  However, mechanical compression may not be the only cause of DVTs in patients with MTS; it seems that chronic arterial pulsations from the right common iliac artery cause trauma to the venous wall leading to "spur formation" that contributes to the formation of DVT in these patients.


|EducationalObjectives=
[[May-Thurner syndrome]] (MTS) is also called iliocaval compression syndrome because it is characterized by the compression of the left iliac vein by an overriding right iliac artery. Patients with [[May-Thurner syndrome|MTS]] are typically young women who present with symptoms consistent with deep vein thrombosis (DVT). The exact incidence and prevalence are still unknown. Other risk factors that predispose patients to an increased risk of thrombosis are also implicated in MTS, including pregnancy and postpartum period, use of oral contraceptive pills, and prolonged immobilization.
[[MTS]] is characterized by the compression of the left iliac vein by an overriding right iliac artery.


Reference:
DVT in [[MTS]] is more common on the left side than the right side because of the anatomic hallmark of the disease, where compression of the left venous side impairs venous return on that side.  However, mechanical compression may not be the only cause of DVTs among patients with MTS; it seems that chronic arterial pulsations from the right common iliac artery cause trauma to the venous wall leading to "spur formation" that also contributes to the formation of DVT among these patients.
Oguzkurt L, Ozkan U, Tercan F, Koc Z. Ultrasonographic diagnosis of iliac vein compression (May-Thurner) syndrome. Diagn Interv Radiol. 2007; 13(3):152-5


Baron HC, Sharms J Wayne M. Iliac vein compression syndrome: A new method of treatment. Am Surg. 2000; 66:653-655.
MTS is initially suspected based on history and physical examination. Work-up includes a venous duplex ultrasound, which may not always demonstrate the site of thrombosis and the status of the iliac vein. Accordingly, some physicians still prefer venography for a definitive diagnosis. Other useful tests may include CT scans with venous phases or MR venography. Unlike other causes of DVT, treatment of MTS includes an endovascular approach and stenting.
|AnswerA=Compression of the left iliac vein by an overriding right iliac artery
|AnswerA=Compression of the left iliac vein by an overriding right iliac artery
|AnswerAExp=May-Thurner syndrome (MTS) is characterized by the compression of the left iliac vein by an overriding right iliac artery.
|AnswerAExp=[[MTS]] is characterized by the compression of the left iliac vein by an overriding right iliac artery.
|AnswerB=Compression of the left iliac vein by an overriding left iliac artery
|AnswerB=Compression of the left iliac vein by an overriding left iliac artery
|AnswerBExp=[[MTS]] is not characterized by the compression of the left iliac vein by an overriding left iliac artery.
|AnswerBExp=MTS is not characterized by the compression of the left iliac vein by an overriding left iliac artery.
|AnswerC=Compression of the left iliac vein by an overriding right iliac vein
|AnswerC=Compression of the left iliac vein by an overriding right iliac vein
|AnswerCExp=[[MTS]] is not characterized by the compression of the compression of the left iliac vein by an overriding right iliac vein
|AnswerCExp=MTS is not characterized by the compression of the left iliac vein by an overriding right iliac vein.
|AnswerD=Compression of the left iliac vein by an overriding left iliac vein
|AnswerD=Compression of the left iliac vein by another overriding left iliac vein
|AnswerDExp=[[MTS]] is not characterized by the compression of the left iliac vein by an overriding left iliac vein.
|AnswerDExp=MTS is not characterized by the compression of the left iliac vein by another overriding left iliac vein.
|AnswerE=Compression of the left iliac vein by the iliac crest
|AnswerE=Compression of the left iliac vein by the iliac crest
|AnswerEExp=[[MTS]] is not characterized by the compression of the  left iliac vein by the iliac crest.
|AnswerEExp=MTS is not characterized by the compression of the  left iliac vein by the iliac crest.
|EducationalObjectives=MTS is characterized by the compression of the left iliac vein by an overriding right iliac artery.
|References=Baron HC, Sharms J, Wayne M. Iliac vein compression syndrome: A new method of treatment. Am Surg. 2000;66:653-655
 
Mousa AY AbuRahma AF. May-Thurner syndrome: update and review. Ann Vasc Surg. 2013;27(7):984-95
 
Oguzkurt L, Ozkan U, Tercan F, Koc Z. Ultrasonographic diagnosis of iliac vein compression (May-Thurner) syndrome. Diagn Interv Radiol. 2007;13(3):152-5
 
 
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=may, thurner, syndrome, may-thurner, May-Thurner, May, Thurner, DVT, deep vein thrombosis, edema, erythema, pain, anatomical, iliac, vein, thrombosis, deep, vein
|WBRKeyword=May, Thurner, Syndrome, May-thurner, DVT, Deep vein thrombosis, Edema, Erythema, Iliac, Vein, Thrombosis, Deep, Vein
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:29, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Vascular
Prompt [[Prompt::A 38-year-old woman presents to the physician's office complaining of pain and swelling in her left leg. Upon further questioning, she informs the physician that she recently returned to the United States from a vacation in Europe. Physical examination is remarkable for erythema, non-pitting edema, and tenderness of the left calf. In contrast, the right leg appears normal. Following appropriate work-up and imaging, the patient is diagnosed with May-Thurner syndrome. Which of the following anatomic findings best characterizes May-Thurner syndrome?]]
Answer A AnswerA::Compression of the left iliac vein by an overriding right iliac artery
Answer A Explanation [[AnswerAExp::MTS is characterized by the compression of the left iliac vein by an overriding right iliac artery.]]
Answer B AnswerB::Compression of the left iliac vein by an overriding left iliac artery
Answer B Explanation AnswerBExp::MTS is not characterized by the compression of the left iliac vein by an overriding left iliac artery.
Answer C AnswerC::Compression of the left iliac vein by an overriding right iliac vein
Answer C Explanation AnswerCExp::MTS is not characterized by the compression of the left iliac vein by an overriding right iliac vein.
Answer D AnswerD::Compression of the left iliac vein by another overriding left iliac vein
Answer D Explanation AnswerDExp::MTS is not characterized by the compression of the left iliac vein by another overriding left iliac vein.
Answer E AnswerE::Compression of the left iliac vein by the iliac crest
Answer E Explanation AnswerEExp::MTS is not characterized by the compression of the left iliac vein by the iliac crest.
Right Answer RightAnswer::A
Explanation [[Explanation::CIA: Common iliac artery, CIV: Common iliac vein courtesy of radiopaedia.org

May-Thurner syndrome (MTS) is also called iliocaval compression syndrome because it is characterized by the compression of the left iliac vein by an overriding right iliac artery. Patients with MTS are typically young women who present with symptoms consistent with deep vein thrombosis (DVT). The exact incidence and prevalence are still unknown. Other risk factors that predispose patients to an increased risk of thrombosis are also implicated in MTS, including pregnancy and postpartum period, use of oral contraceptive pills, and prolonged immobilization.

DVT in MTS is more common on the left side than the right side because of the anatomic hallmark of the disease, where compression of the left venous side impairs venous return on that side. However, mechanical compression may not be the only cause of DVTs among patients with MTS; it seems that chronic arterial pulsations from the right common iliac artery cause trauma to the venous wall leading to "spur formation" that also contributes to the formation of DVT among these patients.

MTS is initially suspected based on history and physical examination. Work-up includes a venous duplex ultrasound, which may not always demonstrate the site of thrombosis and the status of the iliac vein. Accordingly, some physicians still prefer venography for a definitive diagnosis. Other useful tests may include CT scans with venous phases or MR venography. Unlike other causes of DVT, treatment of MTS includes an endovascular approach and stenting.
Educational Objective: MTS is characterized by the compression of the left iliac vein by an overriding right iliac artery.
References: Baron HC, Sharms J, Wayne M. Iliac vein compression syndrome: A new method of treatment. Am Surg. 2000;66:653-655

Mousa AY AbuRahma AF. May-Thurner syndrome: update and review. Ann Vasc Surg. 2013;27(7):984-95

Oguzkurt L, Ozkan U, Tercan F, Koc Z. Ultrasonographic diagnosis of iliac vein compression (May-Thurner) syndrome. Diagn Interv Radiol. 2007;13(3):152-5]]

Approved Approved::Yes
Keyword WBRKeyword::May, WBRKeyword::Thurner, WBRKeyword::Syndrome, WBRKeyword::May-thurner, WBRKeyword::DVT, WBRKeyword::Deep vein thrombosis, WBRKeyword::Edema, WBRKeyword::Erythema, WBRKeyword::Iliac, WBRKeyword::Vein, WBRKeyword::Thrombosis, WBRKeyword::Deep, WBRKeyword::Vein
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