935 - The Mystery of Left Thigh Pain: Varix Causing Nerve Impingement

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MG

Marya Ghazzi, DO

Resident Physician
Icahn School of Medicine at Mount Sinai Physical Medicine and Rehabilitation Residency
New York, New York, United States

Co-Author(s)

FA

Farrah Asaad, DO

Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
PS

Parag Sheth, MD

Chief of Spinal Intervention, Department of Rehabilitation and Human Performance
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Submitter(s)

MG

Marya Ghazzi, DO

Icahn School of Medicine at Mount Sinai
New York, New York, United States

Case Diagnosis: Vascular lesions causing compression of the sciatic nerve and femoral nerve branches with resulting severe left leg pain.

Case Description: An 83-year-old female with a history of rheumatoid arthritis, interstitial lung disease, and diabetes mellitus presented to the clinic with left sided hip and thigh pain. She had prior right lower extremity radiculopathy that improved following synovial cyst resection (10/2023) and lumbar laminotomies (9/3/24 and 12/6/24). However, she developed persistent left lateral hip and thigh pain that worsened with ambulation. Exam was unrevealing; no neurological deficits were noted. MRI of the left hip was then obtained and demonstrated sciatic nerve compression by a venous plexus. EMG, however, was normal. MR neurography was then pursued and revealed an ectatic vein in the vastus lateralis muscle abutting femoral nerve branches. She was referred to a peripheral neurosurgeon and interventional radiology, and sclerotherapy was pursued.

Discussions: Hip or thigh pain with radicular features is often attributed to lumbar spine pathology. However, this case highlights the importance of considering extra-spinal etiologies. The vascular lesion adjacent to both the sciatic nerve and a femoral nerve branch produced neuropathic pain mimicking radiculopathy, despite normal electrodiagnostic studies. MR imaging was essential in making this diagnosis. This multimodal diagnostic approach guided appropriate referral and management. Sclerotherapy was pursued as a minimally invasive treatment to target the vascular malformation. The patient will follow up in clinic after the procedure.

Conclusions: This case underscores the diagnostic complexity of neuropathic pain in elderly patients with multifactorial spinal and systemic comorbidities. Persistent symptoms despite spine-directed interventions should prompt evaluation for alternative causes, including peripheral nerve or vascular lesions. Integration of advanced imaging modalities including MR Neurogram with interdisciplinary management was essential in identifying and treating this patient.