Hospital: HOSPITAL UNIVERSITARIO BASURTO.
Aut@r o Autores: M. Perez Bea, M. Campo Diego, M. Grau Garcia.
Woman aged 70 goes to A&E due to several episodes of dizziness and sensation of weakness while walking along the street. On arrival at A&E she presents loss of consciousness with spontaneous recovery and signs of poor perfusion. -Physical examination showed BP 104/68 and HR 86. Lower left limb is purple and oedematous. -Chronic venous insufficiency of this limb is highlighted in her clinical history. A large retroperitoneal haemorrhage extending towards the pelvic space without signs of active bleeding was identified in the abdominal-pelvic CT. Extensive acute thrombosis appreciated of left superficial, common and iliac femoral vein reaching the lower vena cava. Given the diagnosis of spontaneous retroperitoneal haemorrhage associated with DVT a filter was inserted in the lower vena cava. Favourable evolution with conservative treatment. LMWH (low molecular weight Heparin) was prescribed at prophylactic dosage and the cava filter to be removed 2 months’ later.
Spontaneous retroperitoneal haematoma associated with iliac vein rupture is a lifethreatening emergency. Iliac vein rupture usually occurs due to serious trauma, surgery, etc. Spontaneous occurrence is very rare, and is characteristic of a middle-aged or elderly woman and predominantly on the lefthand side.The characteristic clinical scenario is a middle-aged woman with sudden onset of hypotension, low abdominal pain and non-pulsating mass in left iliac fossa (Lenk’s Triad) with oedema in lower left limb and absence of a traumatic incident. The association of spontaneous iliac vein rupture with DVT or Thrombophlebitis (79% of cases) and May-Thurner Syndrome (28% of cases) has been described. May-Thurner Syndrome (MTS) consists of anatomic pressure of the common left iliac vein by the primitive right iliac artery.
When presented with a middle-aged/elderly woman with spontaneous retroperitoneal haematoma and DVT, iliac vein rupture should be suspected. The characteristic clinical symptoms are: sudden abdominal or lumbar pain, shock and lower left limb oedema.
-Jiang J,Ding X,Zhang G,Su Q,Wang Z,Hu S, et al.Spontaneous retroperitoneal hematoma associated with iliac vein rupture.J Vasc Surg 2010,52:1278-82. - O´Sullivan GJ,Semba CP,Bittner CA,Kee ST,Razavi MK,Sze DY,et al .Endovascular management of iliac vein