May-Thurner综合征：一例致命性未诊断的左髂静脉血栓形成病例报告。
完整摘要 · 中文译文
May-Thurner综合征（MTS），又称髂静脉压迫综合征，是一种由右髂总动脉压迫左髂静脉引起的促血栓形成性疾病，常导致深静脉血栓形成（DVT）。MTS占所有DVT病例的2-5%，且由于深盆腔静脉评估困难，常被漏诊。我们报告一例63岁女性患者，有克罗恩病和脊柱侧弯病史，出现下肢疼痛和静脉溃疡。尽管多普勒超声检查为阴性，并排除了糖尿病和血管炎等其他疾病，患者在一次跌倒后病情恶化，导致心源性休克和死亡。尸检发现左髂静脉内血栓和下腔静脉内栓塞，造成致命的静脉梗阻。组织学检查证实两处均有血栓形成，并将髂静脉血栓判定为血栓机化III期，表明该血栓在临终事件发生前数日已存在。本例强调了对于下肢溃疡和疼痛患者进行全面评估的重要性，因为仅靠多普勒超声可能无法检测到如MTS等更深的静脉异常。在此类病例中，可能需要先进的影像学技术，包括多层螺旋CT静脉造影或磁共振静脉造影，以诊断MTS，从而预防危及生命的并发症。
完整摘要 · 英文原文
May-Thurner syndrome (MTS), also known as iliac vein compression syndrome, is a pro-thrombotic condition caused by the compression of the left iliac vein by the right common iliac artery, often resulting in deep vein thrombosis (DVT). MTS accounts for 2-5% of all DVT cases and is often underdiagnosed due to the difficulty of assessing the deep pelvic veins. We present the case of a 63-year-old female with a history of Crohn's disease and scoliosis, who developed lower limb pain and venous ulcers. Despite negative Doppler ultrasound and exclusion of other conditions such as diabetes and vasculitis, the patient deteriorated after a fall, leading to cardiogenic shock and death. Autopsy revealed a thrombus in the left iliac vein and an embolus in the inferior vena cava, causing fatal venous obstruction. Histological examination confirmed thrombotic formations in both sites and assigned the iliac thrombus to phase III of thrombus organization, indicating that it predated the terminal event by several days. This case underscores the importance of comprehensive evaluation in patients with lower limb ulcers and pain, as Doppler ultrasound alone may not detect deeper venous abnormalities such as MTS. Advanced imaging techniques, including multi-detector computed tomography venography or magnetic resonance venography, may be necessary to diagnose MTS in such cases, preventing life-threatening complications.