Abstract
A 60-year-old patient was diagnosed with endometrial adenocarcinoma. She underwent surgical resection of the tumor followed by chemo-radiation. Later she complained of swelling in her left limb and was found to have thrombosis in the left external iliac vein (EIV). On review of her magnetic resonance venography images, there was a cystic lesion which was projecting into and causing severe compression of the adjacent left EIV (Panel A1: asterisk.). The lesion was hyperintense on T2-weighted images (Panels A1 and B1: arrow) and did not show post-contrast enhancement (Panels A2 and B2: arrow). She subsequently underwent stenting of the vein. However, on repeat computed tomographic (CT) imaging there was evidence of in-stent thrombosis (Panel C: arrow). The cyst was significantly smaller in size on post-intervention imaging. Currently, the patient is doing better symptomatically on conservative management.
Cystic adventitial disease of the venous system is an extremely rare disease. It most commonly affects the iliofemoral veins. 1 Cystic adventitial disease may present as a palpable mass or with unilateral limb swelling. Cystic adventitial disease arises within the adventitia and may cause compression of the vein. 2 Contrast-enhanced CT and MR (magnetic resonance) imaging are invaluable in defining the anatomic location, imaging characteristics and relationship of cystic adventitial disease with the adjacent vessels. 3 The cystic nature and absence of contrast enhancement are better characterized by MRI. In the current case, we have described the rare cause of unilateral limb swelling that needs to be differentiated from its close mimickers such as deep vein thrombosis and from other causes of unilateral limb swelling like tumor, arterial aneurysm or May–Thurner syndrome. 3 Treatment includes conservative management or endovascular/surgical intervention.
‘Images in vascular medicine’ is a regular feature of Vascular Medicine. Readers may submit original, unpublished images related to clinical vascular medicine. Submissions may be sent to: Heather Gornik, Editor in Chief, Vascular Medicine, via the web-based submission system at http://mc.manuscriptcentral.com/vascular-medicine
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.