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Vascular ❯ May-Thurner Syndrome

ProblemIs the IVC and Iliac Veins patent or are they compressed?
ProtocolThis study is often performed when the patient has unexplained lower extremity edema or swelling. The key to looking at the IVC is to detect the presence of thrombus or occlusion but not to overcall the diagnosis. The protocol therefore is usually an issue of being too early rather than too late. We typically will scan from the diaphragm thru the symphysis pubis. Thin section CT and use of coronal multiplanar reconstruction is critical. In select cases and arterial phase at 35 seconds followed by the late venous phase at 90 seconds is done.
Pearls1.The involvement of the IVC by tumor is more common than a primary process of the IVC like an IVC leiomyosarcoma which is rare. IVC involvement is most common with tumors like renal cell carcinoma, adrenal carcinoma and hepatoma. The IVC can also be involved by tumors that arise in the pelvis like endometrial stromal sarcoma
2. involvement of the IVC and especially the iliac veins can be involved by arterial compression. In May Turner Syndrome the classic presentation is the left common iliac artery compressing the left common iliac vein.
3. on early phase imaging it is not uncommon to have “pseudo-thrombus” in the IVC. When in doubt a delayed set of scans is valuable
4. IVC thrombus can occur as a result of trauma, dehydration and septic emboli.

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