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Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, FranceMedical Student, Strasbourg University's Faculty of Medicine, 4 rue Kirschleger, 67085, Strasbourg, FranceINSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, France
A 42-year-old female patient presented to the Emergency Department (ED) for unilateral
edema involving the entire left lower limb that had been rapidly progressing in the
last 24 h. It was associated with blueish skin discolouration and moderate pain (Fig. 1A). The rest of the clinical examination was normal. Regarding medical history, the
patient was previously healthy, used oral oestroprogestative contraception, and was
an active smoker. In the ED, laboratory findings revealed an hyperleukocytosis of
15.38 G/L and an elevated C-Reactive Protein (CRP) leveling at 134.2 mg/L. Given the
high clinical probability of deep vein thrombosis (DVT), a venous Doppler ultrasound
was performed, revealing a deep thrombosis of the common femoral vein, extending to
the deep femoral vein and the popliteal vein. To investigate the extension of the
thrombosis and possible downstream compression of the femoral vein, an injected abdominopelvic
CT scan was performed (Fig. 1B-C). This confirmed complete venous thrombosis of the left iliofemoral venous network
and demonstrated compression of the left common iliac vein (LCIV) by the right common
iliac artery (RCIA) close to the common iliac vein’ bifurcation.
Fig. 1A. Left lower limb edema with blueish skin coloration (with the patient's consent)
B. Abdominal CT-scan (transverse view, venous phase): Left common iliac vein (white
arrow) compressed by the right common iliac artery and associated thrombosis
C. Abdominal CT-scan: Right common iliac vein (RCIV), Left common iliac vein (LCIV),
Right common iliac artery (RCIA) and Left common iliac artery (LCIA).
