E5359. Thigh-High Traffic Jam: A Case-Based Imaging Review of May Thurner Syndrome
  1. Milin Rana; Louisiana State University Health Shreveport
  2. Rachaita Lakra; Louisiana State University Health Shreveport
  3. Megha Chadha; Louisiana State University Health Shreveport
  4. Chaitanya Ahuja; Louisiana State University Health Shreveport
Clinical phases of May Thurner Syndrome (MTS) include a prolonged asymptomatic period of left iliac vein compression followed by gradual development of intraluminal venous fibrous band causing stasis, subsequently progressing to an acute thrombus or embolus formation. Because the screening for MTS in patients with recurrent left leg deep venous thrombosis (DVTs) is not a common practice, diagnosis can either be incidental or a combination of the clinical presentation and objective testing. The goal is to educate the audience in recognizing the variant anatomic features of MTS and a multimodality approach to diagnosis and its complications.

Educational Goals / Teaching Points
The goal is to educate radiologists and residents on the recognition of MTS presentations using multimodal imaging for diagnosis and management including Doppler ultrasound, CT venography, and catheter venography. 1. MTS clinical overview: anatomic relationship, epidemiology, and pathophysiology 2. Imaging features of MTS: ultrasound findings of lower extremity DVT, CT abdomen pelvis venography, and fluoroscopic venography. 3. Management: balloon venoplasty, intravascular stenting, and complications of stent thrombosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present image findings from 14 patients with DVT, nonhealing venous ulcer, and pelvic congestion syndrome that were followed to reach a diagnosis of MTS. We demonstrate CT and venographic findings of left common iliac vein compression by the right common iliac artery resulting in venous stasis. Imaging of treatment with venoplasty and stenting is described alongside postintervention complications, such as stent failure due to repeat thrombosis and postthrombotic syndrome (PTS). Images were analyzed on PACS using MIP and 3D reconstruction.

Multiple factors contribute to underdiagnoses of MTS. Although MTS is rare, it should be considered in the differential diagnosis in middle-age women with chronic and recurrent DVTs. Knowledge of imaging patterns is necessary to appropriately diagnose cases of MTS to allow for early medical and interventional treatment and reduce complications such as PTS, pulmonary embolism, and death.