Volume 49, Issue 4 Winter 2025 JVU 494-208 | A Rare Cause of Lower Extremity Edema: Iliac Vein Compression Following Radical Prostatectomy-A Rare Cause of Lower Extremity Edema: Iliac Vein Compression Following Radical Prostatectomy

A Rare Cause of Lower Extremity Edema: Iliac Vein Compression Following Radical Prostatectomy

Pdf Summary

This 2025 case report from the Journal for Vascular Ultrasound describes a rare instance of right iliac vein compression caused by a post-surgical pelvic mass following radical prostatectomy in a 59-year-old man. The patient presented with right leg edema, discomfort, and unexplained weight gain beginning about one month after surgery. Initial lower extremity venous ultrasound showed abnormal Doppler waveforms in the right iliac and femoral veins but no deep vein thrombosis or reflux. Further pelvic vein ultrasound identified a large (10.0 cm x 6.5 cm) complex hypoechoic non-vascular mass compressing the right common and proximal external iliac veins, with a reduction in vessel diameter and loss of normal venous flow phasicity. Differential diagnoses included seroma, hematoma, or lymphocele.<br /><br />A subsequent computed tomography (CT) scan confirmed the mass as an infected lymphocele, a known but infrequent post-prostatectomy complication. The patient underwent surgical removal of the lymphocele, which led to rapid symptom resolution and normalization of venous waveforms on follow-up ultrasound. This highlights the importance of considering extrinsic iliac vein compression secondary to post-surgical pelvic masses in patients with unexplained unilateral leg edema postoperatively.<br /><br />The report discusses iliac vein compression syndrome (IVCS), typically involving the left side with anatomical variants such as May-Thurner syndrome, but occasionally caused by tumors, inflammation, or post-surgical complications affecting either side. Iliac vein compression restricts venous return causing symptoms like leg swelling, pain, venous insufficiency, and increases risk of deep venous thrombosis. Duplex ultrasound is the primary diagnostic tool, often complemented by CT or MR venography. Treatment varies from conservative management to endovascular stenting or surgery, depending on severity and underlying cause.<br /><br />Color Doppler ultrasound, used cautiously for vessel assessment, was critical in this case for identifying abnormal flow patterns and vessel compression. The case underscores ultrasound’s vital role in diagnosing iliac vein obstruction and directing appropriate management, especially in post-operative patients. Limitations include incomplete surgical history and operative details. Overall, the report advocates for heightened clinical suspicion for iliac vein compression in patients with post-prostatectomy leg swelling and the utility of pelvic vein ultrasound to facilitate timely diagnosis and intervention.

Keywords

iliac vein compression

post-surgical pelvic mass

radical prostatectomy complications

right leg edema

venous ultrasound

infected lymphocele

iliac vein compression syndrome

May-Thurner syndrome

color Doppler ultrasound

deep vein thrombosis risk