Author/Authors :
Zoltowska, Dominika M. Department of Internal Medicine - Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA , Thind, Guramrinder Department of Internal Medicine - Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA , Agrawal, Yashwant Department of Cardiology - St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA , Gupta, Vishal Department of Cardiology - Michigan State University and Borgess Medical Center, Kalamazoo, MI, USA , Kalavakunta, Jagadeesh Kumar Department of Cardiology - Michigan State University and Borgess Medical Center, Kalamazoo, MI, USA
Abstract :
May-Thurner syndrome is an underrecognized anatomical variant that can lead to increased propensity for venous thrombosis in
the lower extremities. We present a case of a 67-year-old female who presented with transient ischemic attack. Initial workup
including CT scan of the head, MRI scan of the head, and magnetic resonance angiogram of the head and neck was
unremarkable. A transthoracic echocardiogram with bubble study was also normal. Subsequently, a transesophageal
echocardiogram was performed that revealed a patent foramen ovale with right-to-left shunt. Lower extremity duplex venous
ultrasound showed no evidence of deep vein thrombosis. However, magnetic resonance venogram of the pelvis showed
compression of the left common iliac vein just after its origin suggestive of May-Thurner syndrome. Hence, May-Thurner
syndrome was recognized as the probable source of paradoxical embolism causing transient ischemic attack in this patient.
