35-year-old male with abdominal pain

Submitted by Eric J. Monroe, MD, Pediatric Radiologist, Department of Radiology, University of Washington, Seattle WA.

A 35-year-old man presents with acute on chronic abdominal pain. The patient has had 4 episodes of pulmonary embolism as well as chronic left lower extremity edema, dermatitis, and wounds.

Figure 1 Figure 2

Figure 3

History and imaging are most consistent with which of the following diagnoses?

Kippel-Trénaunay-Weber syndrome
May-Thurner syndrome
Phlegmasia cerulea dolens
Primary venous leiomyosarcoma
Nutcracker syndrome

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