823 - May-Thurner Syndrome Presenting as Chronic DVT in a Young Adult with Genetic Cerebral Palsy: A Case Report

Case Diagnosis: May-Thurner Syndrome

Case Description: A 19 year-old female with a history of oral contraceptive use, duplication on chromosome 2q manifesting as cerebral palsy, intellectual disability, and neuromuscular scoliosis, presented to pediatric rehabilitation clinic for mobility assessment. She was noted to have left leg pain with intolerance to prolonged sitting as well as intermittent foot discoloration. A doppler ultrasound was obtained revealing a chronic left femoral vein deep venous thrombosis. Hematology consultation recommended left lower extremity vascular CT scan and venography which demonstrated severe stenosis of the left common femoral vein extending to the left common iliac vein with extensive pelvic venous plexus collaterals diagnostic for May-Thurner Syndrome (MTS) also known as iliac vein compression syndrome. Multistation venoplasty was performed by interventional radiology, with repeat venography showing improved flow through the left common iliac, external iliac, and common femoral veins. At follow-up, it was noted that the patient reported improvement in pain and sitting tolerance.

Discussions: Pain is common in adults with cerebral palsy and may be multifactorial. Comorbid intellectual disability may impact a patient’s ability to localize, characterize, and describe pain. MTS is a rare condition in which the left iliac vein is compressed by the overlying right common iliac artery resulting in insufficiency, stenosis, and obstruction. It is a risk factor for pain, chronic DVT, and pulmonary embolism.

Conclusions: This case highlights the importance of heightened clinical suspicion for atypical etiologies of pain in patients with neurodevelopmental disability, particularly in the setting of deviation from functional baseline. Prompt recognition and diagnosis of chronic DVT associated with May-Thurner Syndrome allowed physiatrists to coordinate multidisciplinary interventions, relieve symptoms, and mitigate morbidity and mortality associated with chronic venous thromboembolism in this patient.