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A Case of Fatal Iliac Vein Rupture Associated With May-Thurner Syndrome

Hughes, Rhome L. MD*; Collins, Kim A. MD; Sullivan, Karen E. MD

The American Journal of Forensic Medicine and Pathology: September 2013 - Volume 34 - Issue 3 - p 222–224
doi: 10.1097/PAF.0b013e31829f6753
Case Reports

May-Thurner syndrome results from long-standing compression of the left common iliac vein (LCIV) and is characterized by the formation of intraluminal spurs leading to obstruction of blood flow and deep vein thrombosis (DVT). Increased intraluminal pressures may occur as a consequence of venous obstruction, which when coupled with other factors thought to further weaken venous wall integrity (ie, inflammation or hormonal imbalances) may produce spontaneous (nontraumatic) and potential lethal venous rupture.

We report a case of DVT in a woman with previously undiagnosed May-Thurner syndrome and heterozygosity for factor V Leiden mutation on exogenous hormone therapy, with subsequent spontaneous rupture of the LCIV leading to fatal hemoperitoneum. Autopsy revealed fibrous obliteration of the junction between the LCIV and inferior vena cava with associated DVT, transmural venous rupture, and thrombophlebitis.

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From the *Regional Medical Examiner, Armed Forces Medical Examiner System, San Antonio Military Medical Center, TX; and †Fulton County Medical Examiner’s Office, Atlanta, GA.

Manuscript received June 29, 2012 accepted December 5, 2012.

The opinions expressed on this document are solely those of the author(s) and do not represent an endorsement by or the views of the US Air Force, the Department of Defense, or the US Government.

The authors report no conflicts of interest.

Reprints: Rhome L. Hughes, MD, Regional Armed Forces Medical Examiner, Department of Pathology, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, Suite 1 Lackland AFB, TX 78236. E-mail:

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© 2013 by Lippincott Williams & Wilkins.