PMC10260311_01
(a) Image from CT abdomen pelvis with contrast demonstrating pelvic varicosities as well as a large pseudoaneurysm (white arrow) surrounded by hematoma (star) anterior to a fractured sacrum (black arrow). (b) Additional CT image demonstrating compression of the left common iliac vein (black arrow) between the overlying right common iliac artery (white arrow) and the underlying vertebral body (star), typical of MTS anatomy.
CRIVAM2023-9003408.001.jpg
PMC10260311_01_CRIVAM2023-9003408.001.jpg
fig1
When reviewing the patient's abdominopelvic CT, the IR service noted that the presacral hematoma surrounded a large venous pseudoaneurysm arising from large varicosities originating from the left internal iliac vein (Figure 1). Also appreciated was significant compression of the left common iliac vein between the overlying right common iliac artery and the fifth lumbar vertebral body, consistent with a possible May-Thurner lesion that could be the etiology of the patient's large pelvic varicosities (Figure 1).
(a) Digital subtraction venography image demonstrating compression and narrowing of the left common iliac vein (white arrow) and a large venous pseudoaneurysm arising from pelvic varicosities (black arrow). These findings correspond with those seen on CT in Figure 1. (b) A digital subtraction venography image demonstrating the anatomic flow of contrast through the bilateral "kissing" iliac vein stents with resolution external compression of the left common iliac vein and associated narrowing. Also note that the pelvic varicosities and associated pseudoaneurysm are no longer visualized.
CRIVAM2023-9003408.002.jpg
PMC10260311_01_CRIVAM2023-9003408.002.jpg
fig2
Venography demonstrated apparent external compression of the left common iliac vein with retrograde flow of contrast down the left internal iliac vein and into the large presacral varicosities (Figure 2). Completion angiography demonstrated laminar flow of contrast through the stented veins and into the IVC with accompanying cessation of flow through the pelvic varicosities including the previously noted venous pseudoaneurysm (Figure 2).