May-Thurner syndrome: a forethought for asymptomatic pulmonary embolism

May-Thurner syndrome (MTS) is a clinicopathological condition where the left common iliac vein is compressed by the overlying right common iliac artery, potentially leading to deep vein thrombosis (DVT) or obstruction to venous outflow. Unlike in DVT due to other causes, pulmonary embolism is not a frequent association of MTS. We report a man in his 30s who presented with left lower limb pain and swelling, without chest pain or shortness of breath. A contrast CT angiography of the abdomen and pelvis revealed a left common iliac, external iliac and femoral extensive DVT due to MTS. Incidental bilateral segmental pulmonary emboli were detected at the covered lung bases. He underwent direct catheter thrombolysis of his left side DVT and later a stent placement in the common iliac vein. This report highlights the under-recognised presentation of MTS in patients with DVT and emphasises the role of early endovascular intervention in improving clinical outcomes and preventing long-term complications.