Attending Physician Mount Sinai Hospital New York, New York, United States
Case Diagnosis: A 29 year-old male who developed May Thurner syndrome secondary to heterotopic ossification after a complete thoracic spinal cord injury.
Case Description: A 29 year old male with no significant PMH was admitted to acute inpatient rehab after a T10 AIS A spinal cord injury following an MVA. He began noting proximal LLE swelling and pain. Dopplers of the LLE were negative for DVT. Due to continued swelling, a CT A/P venogram was performed to further assess vasculature. This showed a 7cm subacute hematoma in the anterior left thigh with mineralization suggestive of HO, with associated compression of the left common iliac vein concerning for May-Thurner syndrome. Bone scan was then performed which demonstrated signs of active HO in this area. Ultimately the patient was treated with a one time dose of radiation therapy to the area of active HO. In the following weeks, the patient noted improvement of LLE swelling and pain.
Discussions: While heterotopic ossification is a common complication of spinal cord injury and can lead to vascular compression, there is no current literature describing cases of HO leading to May-Thurner syndrome. May-Thurner Syndrome is the compression of the iliac vein against the lumbar spine, usually by an overlying iliac artery, resulting in venous insufficiency, stenosis, and obstruction. Clinical presentation of May-Thurner syndrome can be variable, but some may describe acute onset of lower extremity pain and edema, as in our case. The patient’s pain and swelling ultimately improved after treatment of the HO.
Conclusions: Heterotopic ossification can commonly occur after spinal cord injuries, and can lead to pain, swelling, and decreased range of motion. Vascular compression due to HO, such as in this case demonstrating May-Thurner Syndrome, should remain on the differential in a spinal cord injury patient who presents with acute lower extremity swelling or pain.
