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Acute bilateral pulmonary embolism in a 21-year-old: is May-Thurner syndrome in our differential?
  1. Rajarshi Bhadra1,
  2. Meyappan Somasundaram1,
  3. Daniel V Iltchev2 and
  4. Keyvan Ravakhah1
  1. 1 Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
  2. 2 Department of Pulmonary and Critical Care Medicine, St. Vincent Charity Medical Center, Cleveland, Ohio, USA
  1. Correspondence to Dr Rajarshi Bhadra, drrajarshibhadra{at}


May-Thurner syndrome (MTS) is a clinical condition where the left common iliac vein gets compressed by the overlying right common iliac artery anterior to the fifth lumbar vertebra and the sacral promontory. It results in vessel wall injury and predisposition to thrombosis. We present a case of a 21-year-old African-American man with no significant past medical history who came to the emergency department with left lower limb swelling associated with shortness of breath, and was eventually diagnosed to have extensive left lower extremity deep vein thrombosis (DVT) along with acute bilateral extensive pulmonary embolism (PE) as a consequence to MTS. MTS should be considered in the differential when young patients present with unprovoked or recurrent left-sided DVT. Diagnosis of this anatomical variant is critical as it may need long-term anticoagulation and consideration of pharmaco-mechanical intervention such as mechanical thrombectomy and venoplasty with or without stenting.

  • venous thromboembolism
  • pulmonary embolism

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  • Contributors RB was involved in planning, conduct, reporting, conception and design, acquisition of data and interpretation of data. He was also directly involved in patient care. MS was the primary attending under whose care the patient was admitted. He was involved in overall foreseeing the data and recommendations as needed. DVI was the pulmonary and critical care consultant involving in caring for the patient. Overall the literature review and managing the final texture of the article can be attributed to his credit. KR has been involved in the overall review, incorporating valuable input as regards patient care experience and final drafting the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.