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A case of fatal iliac vein rupture associated with May-Thurner syndrome

Rhome L Hughes1, Kim A Collins, Karen E Sullivan

  • 1Regional Medical Examiner, Armed Forces Medical Examiner System, San Antonio Military Medical Center, TX 78236, USA. rhomehughes@gmail.com

The American Journal of Forensic Medicine and Pathology
|July 26, 2013
PubMed

Insights

May-Thurner syndrome, a condition causing left common iliac vein compression and deep vein thrombosis (DVT), can lead to fatal venous rupture. This case highlights the lethal potential of undiagnosed May-Thurner syndrome combined with other risk factors.

Area of Science:

  • Vascular Surgery
  • Hematology
  • Pathology

Background:

  • May-Thurner syndrome involves left common iliac vein compression, leading to obstruction and deep vein thrombosis (DVT).
  • Venous obstruction can increase intraluminal pressures, potentially weakening vein walls.
  • Factors like inflammation and hormonal imbalances may further compromise venous integrity.

Observation:

  • A case of deep vein thrombosis (DVT) in a woman with undiagnosed May-Thurner syndrome is presented.
  • The patient was also heterozygous for the factor V Leiden mutation and on exogenous hormone therapy.
  • This combination led to spontaneous rupture of the left common iliac vein (LCIV).

Findings:

  • Autopsy confirmed fibrous obliteration at the LCIV-inferior vena cava junction.
  • Evidence of deep vein thrombosis (DVT) and transmural venous rupture was observed.
  • Thrombophlebitis was also noted as a contributing pathological finding.

Implications:

  • This case underscores the potentially lethal consequences of undiagnosed May-Thurner syndrome, especially with coexisting risk factors.
  • It highlights the critical role of early diagnosis and management of venous thromboembolic disorders.
  • The findings emphasize the importance of considering May-Thurner syndrome in patients presenting with unexplained DVT and risk factors for venous wall compromise.

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