Gozzo Cecilia, Farina Renato, Coppolino Pietro, Cancemi Giovanna, Foti Pietro Valerio, Palmucci Stefano, Venturini Massimo, Basile Antonio
Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Radio diagnostic and Radiotherapy Unit, Catania, Italy.
Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Varese, Italy.
Radiol Case Rep. 2021 Apr 29;16(7):1608-1612. doi: 10.1016/j.radcr.2021.04.020. eCollection 2021 Jul.
May-Thurner syndrome (MTS) belongs to a group of uncommon vascular syndromes. It consists in left common iliac vein (LCIV) compression between the right common iliac artery (RCIA) anteriorly and the lumbar spine posteriorly. A compression of LCIV by the left common iliac artery (LCIA) or by both iliac arteries were described. We present a rare case of "double MTS" which consist in double stenosis of LCIV by both RCIA and LCIA. Double MTS can cause acute or chronic DVT; this latter could be clinical manifest or well compensated. A 58-year-old woman with chronic mild pelvic pain underwent Doppler Ultrasound (US) of the pelvis and lower extremity vessels which showed thrombosis of both LCIV and ipsilateral common femoral vein caused by the extrinsic compression by both common iliac arteries against the spine. CT angiography confirmed the US data and ruled out other causes of compression. CT scan also showed the development of a natural venous femoro-femoral bypass which allowed to counteract the venous stasis and compensate venous drainage. Therefore, we decide for a long-term prophylaxis with anticoagulant drugs and doppler US follow-up at 6 months. In conclusion, doppler US is a non-invasive, low-cost, repeatable and sensitive method which allows to diagnose MTS and associated DVT. It may be considered the first level exam which allows to easily detect pelvic vascular compression syndrome.
梅-图二氏综合征（MTS）属于一组罕见的血管综合征。它是指左髂总静脉（LCIV）在前方受右髂总动脉（RCIA）和后方受腰椎压迫。也有左髂总动脉（LCIA）或双侧髂动脉压迫LCIV的描述。我们报告一例罕见的“双MTS”病例，即LCIV被RCIA和LCIA双重狭窄。双MTS可导致急性或慢性深静脉血栓形成（DVT）；后者可能临床表现明显或代偿良好。一名58岁慢性轻度盆腔疼痛的女性接受了盆腔和下肢血管的多普勒超声（US）检查，结果显示双侧髂总动脉对脊柱的外在压迫导致LCIV和同侧股总静脉血栓形成。CT血管造影证实了超声检查结果并排除了其他压迫原因。CT扫描还显示了一条天然的股-股静脉旁路的形成，这有助于抵消静脉淤滞并补偿静脉引流。因此，我们决定使用抗凝药物进行长期预防，并在6个月后进行多普勒超声随访。总之，多普勒超声是一种无创、低成本、可重复且敏感的方法，可用于诊断MTS及相关的DVT。它可被视为能够轻松检测盆腔血管压迫综合征的一级检查方法。
