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￭ Sun-193 ￭
Right-sided May-Thurner syndrome caused by lumbar osteophyte
삼육서울병원
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박규현, 조욱현, 안효승, 이영수, 황재연, 이한희, 오장량
Background: May-Thurner syndrome comprises conditions leading to venous outflow obstruction caused by extrinsic compression in the iliocaval venous territory. Usually it is left sided because the most common variant is characterized by collapsed left iliac vein between right common iliac artery and lumbar vertebrae. Case presentation: Right-sided May-Thurner syndrome cases, which are caused by vascular anomaly (eg. left-sided inferior vena cava) are rarely reported. We experienced an atypical case of right common iliac vein compression between right common iliac artery and protruding osteophyte of 4th lumbar vertebra. A 79-year-old woman visited ER with right whole leg swelling and pain. She had chronic back pain caused by osteoporotic change and compression fracture of lumbar vertebrae. D-dimer level was above 4.4μg/mL. Lower extremity doppler sonography was done under impression of deep vein thrombosis. Venous thrombosis was found along right femoral vein to popliteal vein. CT venography was done to estimate the location and extent of the thrombi. The CT venogram revealed proximal part of right common iliac vein collapsed between right common iliac artery and protruding lumbar osteophyte. Thrombi was filled distal to the collapsed lesion along to popliteal vein (Fig A, B). We planned to treat her with catheter-directed thrombolysis and angioplasty with stenting at the collapsed segment. But she could not lie down on the catheterization bed for a moment because of her back pain. So we treated her with anticoagulation with oral direct factor Xa inhibitor (rivaroxaban). Sixteen months have passed after discharge and the swelling of right whole leg has been diminished. Conclusion: Based on the findings above, we suggest that right-sided May-Thurner syndrome should be suspected in pa- tients presenting with back pain and right whlole leg swelling after other common possibilities are ruled out.
￭ Sun-194 ￭
A case of dilated cardiomyopathy due to acromegaly.
울산의대 서울아산병원
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전주향, 이상언
Acromegaly results from hypersecretion of growth hormone(GH). As a result there will be average 10-year reduction in survival year. Almost 60% of the patients die from cardiovascular complications and these include hypertension, left ventricular hypertrophy, cardiomyopathy, arrhythmia, and coronary ar- tery disease. Hypertension and coronary artery disease are two very important factors in determining the prognosis. These complications are reported to be relatively irreversible. We reported a case of acromegaly in a 37-year old male who was not diabetic and hypertensive, but with dilated cardiomyopathy.
The report’s objective was to seek out the course of acromegaly with dilated cardiomyopathy. The main symptom of the patient was palpitation.
Echocardiogram findings were showing PVC(the portion was 11%, holter) and left bundle branch block. Kept in mind the left ventricular dysfunc- tion(LVEF 13%, EDV 735ml) with left bundle branch block(QRS duration>150ms) we attempted cardiac resynchronization therapy but failed due to coro- nary sinus anomaly. There was no sign of coronary lesion and the delayed myocardial enhancement MRI demonstrated mid-wall pattern. Diagnosed as di- lated cardiomyopathy previously in 2012 and had been continuously treated with optimal medical therapy for 5 years, LV dysfunction did not improved and Vo2max was 12.13 3.1 METS. The patient underwent heart transplantation after all the analysis we found did not show any proof of reversible factors.
Excessive exposure to GH to the myocardium develops myocardial hypertrophy causing interstitial remodeling in which ultimately leads to LV dysfunction. Acromegaly can be first presented as dilated cardiomyopathy, and without proper management, the refractory end-stage heart failure can be followed as a complication, leading to heart transplantation. Therefore this complication must be recognized at earliest stage. If we do not diagnosed acro- megly before the transplantation, there will be a possibilty of recurring heart failure due to exposure from remaining GH. Therefore in the case of patient with previous HF presenting typical clinical features of acromegaly, the diagnostic evaluation might be needed
