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Spontaneous Iliac Vein Rupture.

Kim DH, Park HS, Lee T - Vasc Specialist Int (2015)

Bottom Line: Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation.Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding.This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT
Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation. This is a case report of SIVR in a 62-year-old female who presented to the emergency room with left leg swelling. Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding. She was managed conservatively without surgical intervention, and also underwent inferior vena cava filter insertion and subsequent anticoagulation therapy for pulmonary thromboembolism. This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.

No MeSH data available.


Related in: MedlinePlus

Initial abdominopelvic computed tomography showing (A) rupture of the left external iliac vein (EIV) with a hematomoa annotated by arrows. (B) A large hematomoa on the medial side of the left EIV annotated by arrows. (C) Wide-range deep vein thrombosis from left common iliac vein to left popliteal vein. (D) May-Thurner syndrome, overwhelmed iliac vein was annotated.
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f1-vsi-31-62: Initial abdominopelvic computed tomography showing (A) rupture of the left external iliac vein (EIV) with a hematomoa annotated by arrows. (B) A large hematomoa on the medial side of the left EIV annotated by arrows. (C) Wide-range deep vein thrombosis from left common iliac vein to left popliteal vein. (D) May-Thurner syndrome, overwhelmed iliac vein was annotated.

Mentions: A contrast-enhanced computed tomography (CT) was then obtained (Fig. 1), revealing a hematoma in the pre-vesical area. Although there was no evidence of active contrast leakage on CT, rupture of the left external iliac vein (EIV) was highly suspicious (Fig. 1A). The presumed rupture site of the EIV was on the medial side, as shown by the location of a large hematoma (Fig. 1B). Deep vein thrombosis (DVT) of the left common iliac, external iliac, femoral and popliteal veins was also observed (Fig. 1C) and findings consistent with May-Thurner syndrome could be seen (Fig. 1D). She was immediately managed with hydration and red blood cell (RBC) transfusion and a decision to monitor her closely in the intensive care unit (ICU) was made instead of performing an emergency operation. Her hemoglobin and hematocrit levels rose to 8.8 g/dL and 26.2% respectively after initial resuscitation.


Spontaneous Iliac Vein Rupture.

Kim DH, Park HS, Lee T - Vasc Specialist Int (2015)

Initial abdominopelvic computed tomography showing (A) rupture of the left external iliac vein (EIV) with a hematomoa annotated by arrows. (B) A large hematomoa on the medial side of the left EIV annotated by arrows. (C) Wide-range deep vein thrombosis from left common iliac vein to left popliteal vein. (D) May-Thurner syndrome, overwhelmed iliac vein was annotated.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508654&req=5

f1-vsi-31-62: Initial abdominopelvic computed tomography showing (A) rupture of the left external iliac vein (EIV) with a hematomoa annotated by arrows. (B) A large hematomoa on the medial side of the left EIV annotated by arrows. (C) Wide-range deep vein thrombosis from left common iliac vein to left popliteal vein. (D) May-Thurner syndrome, overwhelmed iliac vein was annotated.
Mentions: A contrast-enhanced computed tomography (CT) was then obtained (Fig. 1), revealing a hematoma in the pre-vesical area. Although there was no evidence of active contrast leakage on CT, rupture of the left external iliac vein (EIV) was highly suspicious (Fig. 1A). The presumed rupture site of the EIV was on the medial side, as shown by the location of a large hematoma (Fig. 1B). Deep vein thrombosis (DVT) of the left common iliac, external iliac, femoral and popliteal veins was also observed (Fig. 1C) and findings consistent with May-Thurner syndrome could be seen (Fig. 1D). She was immediately managed with hydration and red blood cell (RBC) transfusion and a decision to monitor her closely in the intensive care unit (ICU) was made instead of performing an emergency operation. Her hemoglobin and hematocrit levels rose to 8.8 g/dL and 26.2% respectively after initial resuscitation.

Bottom Line: Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation.Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding.This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT
Spontaneous iliac vein rupture (SIVR) is a rare entity, which usually occurs without a precipitating factor, but can be a life-threatening emergency often requiring an emergency operation. This is a case report of SIVR in a 62-year-old female who presented to the emergency room with left leg swelling. Workup with contrast-enhanced computed tomography revealed a left leg deep vein thrombosis with May-Thurner syndrome and a hematoma in the pelvic cavity without definite evidence of arterial bleeding. She was managed conservatively without surgical intervention, and also underwent inferior vena cava filter insertion and subsequent anticoagulation therapy for pulmonary thromboembolism. This case shows that SIVR can be successfully managed with close monitoring and conservative management, and anticoagulation may be safely applied despite the patient presenting with venous bleeding.

No MeSH data available.


Related in: MedlinePlus