Sciatic nerve compression by a gluteal vein varicosity

A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed an L5‐S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1‐3].