WBR0723: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{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> 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 [[May-Thurner syndrome|MTS]] are typically young women who present with symptoms consistent with deep vein thrombosis (DVT).


[[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 females 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 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.
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=
[[MTS]] is characterized by the compression of the left iliac vein by an overriding right iliac artery.
 
Reference:
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.
|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= [[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=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.
|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
}}
}}

Revision as of 02:10, 16 September 2014
Author [[PageAuthor::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 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.
Educational Objective: MTS is characterized by the compression of the left iliac vein by an overriding right iliac artery.
References: 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.]]

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
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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