Submit Manuscript | http://medcraveonline.com Abbreviations: DVT, Deep Vein Thrombosis; VTE, Venous Thromboembolism Case presentation A 45 year old post-menopausal female presented to her primary physician with complaints of left foot swelling which gradually progressed to involve the entire left lower limb. She did not give any antecedent history of trauma, ulceration on lower limb, haematuria, lower urinary tract symptoms, bowel complaints, vaginal bleeding, loss of weight, loss of appetite, previous history of DVT. There was no history of previous surgeries and co-existing morbidities. Her left lower limb was reddish in color, tense and tender to touch. Per- vaginal examination revealed induration with in the left fornix. Rest of the general and systemic examination, were within normal limits. A venous Doppler revealed a partial thrombus of the Left Proximal external iliac vein and Left Common Iliac vein. Thrombophillic screen (PT-INR, aPTT, Protein C, Protein S, D, and Factor V Leiden Mutation) was within normal limits. Patient was started on Warfarin and put on total bed rest. Due to absence of any predisposing factors, further evaluation was considered and an ultrasound of the abdomen was done. It revealed a grossly dilated left renal pelvis with thinned out parenchyma & a 1.3*1.1cm lesion near the left vesico- ureteric junction. Contrast-Enhanced CT of Abdomen & Pelvis Figure 1 was done which shows poorly functioning left kidney with gross hydronephrosis & thinned out parenchyma, large 6.6*4.5cm heterogeneously enhancing solid cystic mass in the left ureter at the level of the iliac vessel crossing and 3.5*2.1cm heterogeneously enhancing solid cystic lesion in left distal ureter extending up to VUJ. Her hemoglobin, serum creatinine, liver function tests, urinalysis were within normal limits. Urine for malignant cytology was negative. Cystoscopy showed a bulge just lateral to the left ureteric orifce and no other visible mass. The left ureteric orifce could not be cannulated. Considering the diagnosis of a ureteric mass, a Left Nephrouretectomy with bladder cuff excision was planned. Warfarin was stopped 5 days before surgery and patient was put on bridging therapy with low molecular weight heparin. A cardiology consult was taken and it was decided to insert an IVC flter 24 hours before surgery as prophylaxis to decrease risk of intra-operative and post- operative pulmonary embolism. Intra-operatively DVT pump was not applied. A Radical Nephroureterectomy along with Hysterectomy and Left Salpingo-oophorectomy (Figure 2) (Figure 3) was done with gynecological assistance in view of local invasion of cervix. Mid ureteric mass was dissected off the iliac vessels with CTVS assistance and fnal specimen consisted of the Left kidney, ureter, Uterus, Left Ovary along with Lymph Node dissection. Total intra-operative blood loss was 600ml. Post-operatively patient was kept in the ICU before shifting to the ward. Warfarin was re-started on day 3. Patient had a relatively uneventful post-operative period. Figure 1 Pre-op CECT Abdomen + Pelvis( Upper half – Coronal Section, Lower half- Sagittal section. Urol Nephrol Open Access J. 2018;6(3):112‒114. 112 © 2018 Sharma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. A ureteral mass presenting as deep vein thrombosis: a very rare presentation Volume 6 Issue 3 - 2018 Dushiant Sharma, Umesh Sharma, Sumit Gehlawat Department of Urology, RML Hospital & PGIMER, Delhi, India Correspondence: Dushiant Sharma, Department of Urology, Dr RML Hospital & PGIMER, Baba Khadak Singh Marg, New Delhi, 110001, Tel 011-2340-4323, Email dushiant@gmail.com Received: November 15, 2018 | Published: June 22, 2018 Abstract Venous Thromboembolism is a dreaded condition. Many conditions and systemic diseases are known to predispose to its occurrence including malignancy, pancreatitis, burns, clotting disorders and direct compression. All of these have been known to affect one or more factors in Virchows Triad proposed roughly a century ago. 1 It consists of Hypercoagulability, Vascular Endothelial Dysfunction, Stasis. Stasis, one of the factors in Virchows triad has been studied to a very small extent and it is this feature that is mostly responsible for the development of Deep Vein Thrombosis (DVT) due to direct compression. Iliofemoral thrombosis in malignancy patients can be caused due to vein compression by pelvic malignancy and usually presents as unilateral lower limb swelling. In patients with sudden onset of unilateral lower limb swelling without any perceived or diagnosed medical condition, detailed evaluation may lead to early identifcation, appropriate management and possibly cure. We present a case of acute unilateral ilio-femoral DVT caused by external compression by a mid-ureteric mass. Keywords: deep vein thrombosis, ileofemoral thrombosis, ureteric malignancy, upper tract urothelial cancers Urology & Nephrology Open Access Journal Case Report Open Access