Vascular Ultrasound – May-Thurner Syndrome

January 7, 2011
by Shannon Peron, RDCS, RVT

Iliac VesselsEvery now and then an interesting question will make me feel the need to answer it in a post with the thought of opening up the floor for a community discussion.

Here’s the latest question (in a nutshell):

Why does more lower extremity DVT’s seem to start in the left leg versus the right leg?

It is likely due to the vessel anatomy of the left pelvic region.  The left common iliac vein lies posterior to the right common iliac artery causing a compression of the vein that is thought to be a contributing factor to the development of DVT.

Now for a side story and question:

A young woman, recently post-partum, presented to an urgent care with severe pain in her left leg. The physician on-duty orders a venous duplex scan to rule out DVT. The technologist performing the exam determines it to be negative for DVT (no blood clot present). So the young woman is discharged with appropriate instructions. Two days later the same young woman returns to the urgent care with a severe increase in the level of pain in her left leg. Once again, a venous duplex scan is ordered. The exam is now performed by technologist number 2. And of course, DVT from top to bottom. Undeniable, no flow whatsoever, DVT.

Of course, this situation raised some eyebrows. The two scans were compared and it was determined that neither of the two technologists were wrong.

Anyone care to venture a guess or speculate what may have occurred or what the patients’ diagnosis was?

You have the floor my friends!

Update/Edit:

A more discerning eye noticed that the spectral doppler analysis of flow in the CFV on scan number one demonstrated loss of phasicity.

(This is why I don’t write case studies)

Happy Scanning!!!

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  • Mary Escano

    I guess if she’s immobile during the period of 2 days and if she’s taking a coagulating medicine then, I wouldn’t be surprised if she suddenly develops DVT.

    • Shannon Peron, RVT, RDCS

      Okay, I’m terrible. Here is an edit I will add to the post. Spectral doppler in the CFV on scan number one demonstrated loss of phasicity.

  • http://yours Lorrie

    I think that the tech may not have scanned in the iliac region, she may have already had the makings of iliac DVt, that over the next 2 days extended to the SFJ and down the leg! Plus being off her feet for a period of time doesn’t help either:)!

  • Shannon Peron, RVT, RDCS

    This patient did have something brewing. She was diagnosed with May-Thurner Syndrome and treated with thrombolytics and a stent.

  • isabel

    Hey Shannon, thanks for sharing!

    • http://www.vascularultrasound.net Shannon Peron, RDCS, RVT

      Any time.

  • Guest

    In reference to the story and question. This is not that unusual. A clot can develop very quickly. Negative in the morning and positive in the afternoon. Of course this woman has a risk factor that most don’t, the May-Thurner Syndrome. Does this happen often or everyday no but it’s not unheard of.

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