May-Thurner Syndrome with Double Compression of the Iliac Vein: Lessons Based on a Case Report

BACKGROUND May-Thurner syndrome, also known as Cockett's syndrome, is characterized by vascular alterations due to stenosis of the left iliac vein, usually caused by compression against the vertebral column by the right iliac artery. Doppler ultrasound represents the first level of examination for the study of this vascular pathology, and allows a very accurate study of the lower-limb vessels. We describe an unusual presentation with double stenosis of the left common iliac vein. CASE REPORT A 73-year-old woman came to the clinic for acute onset of worsening dyspnea, with lymphedema of the left lower limb, and was examined using ultrasound and multidetector computed tomography. The Doppler ultrasound exam showed 2 compressions of the common iliac vein by the right and left iliac artery due to a combination of osteophytosis of the vertebral column and reduced distance between the left iliac vein and the spine. CONCLUSIONS May-Thurner syndrome should be suspected in patients with symptoms of venous stasis of the left lower limb. Doppler ultrasound identified stenosis of the common iliac vein and the consequent flow changes. Failure to diagnose and treat May-Thurner syndrome could expose patients to very serious risks to their health.