Venous Insufficiency in Patient with May-Thurner Syndrome and Family History of Cardiovascular Disease

Case at a Glance

A 35-year-old woman with diagnosed May-Thurner syndrome and tortuous left ovarian vein presents with bilateral lower extremity symptoms and concerns about venous duplex ultrasound findings. She has significant family history of cardiovascular disease and genetic markers for cardiac conditions.

Patient's Story

The patient reports daily lower extremity swelling, discoloration (red/purple), and heavy, achy sensations that worsen throughout the day. Symptoms are significant enough to require elevation and rest by early evening. She has been previously diagnosed with May-Thurner syndrome and tortuous left ovarian vein. The patient expresses concern about her family history of premature cardiovascular events, with multiple relatives experiencing heart failure, myocardial infarction, and stroke between ages 50-60.

Initial Assessment

Physical examination revealed a 35-year-old female, height 5'5", weight 150 lbs, presenting with lower extremity venous symptoms. Patient reported genetic testing positive for markers associated with vascular and cardiac conditions, including an uncertain pathogenic variant for arrhythmogenic right ventricular cardiomyopathy (ARVC). Strong family history of premature cardiovascular disease was noted.

The Diagnostic Journey

Venous duplex ultrasound of bilateral lower extremities was performed due to symptomatic venous insufficiency. Initial cardiology consultation reported normal findings, but patient sought second opinion due to concerns about ultrasound images showing mixed color patterns and apparent vessel irregularities. Patient was particularly concerned about potential venous regurgitation based on her research.

Final Diagnosis

Venous duplex ultrasound findings were determined to be within normal limits. The mixed color patterns observed were identified as aliasing artifacts due to high-velocity flow, not pathological regurgitation. Apparent vessel narrowing and irregularities were explained as normal anatomical variations and imaging artifacts related to vessel orientation and junction anatomy.

Treatment Plan

Conservative management with continued elevation and symptom monitoring. Patient education regarding normal ultrasound findings and differentiation between pathological findings and imaging artifacts. Continued surveillance for underlying May-Thurner syndrome and ovarian vein issues as clinically indicated.

Outcome and Follow-up

Patient reported significant relief after explanation of normal ultrasound findings. Symptoms attributed to previously diagnosed May-Thurner syndrome and ovarian vein tortuosity. Ongoing monitoring recommended given family history and genetic predisposition to cardiovascular disease.