Plantar vein thrombosis: a rare cause of plantar foot pain
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CASE REPORT
Plantar vein thrombosis: a rare cause of plantar foot pain Daniel S. Siegal & Jim S. Wu & Darren D. Brennan & Tracy Challies & Mary G. Hochman
Received: 8 August 2007 / Revised: 16 October 2007 / Accepted: 22 October 2007 / Published online: 5 December 2007 # ISS 2007
Abstract Plantar vein thrombosis is a rare condition, with only a handful of cases reported in the literature. The cause is unknown; however, the disease has been attributed to prior surgery, trauma, and paraneoplastic conditions. We present a case of a 32-year-old female runner with plantar vein thrombosis diagnosed on contrast-enhanced MRI and confirmed on ultrasound. The symptoms resolved with conservative treatment and evaluation revealed the presence of a prothrombin gene mutation and use of oral contraceptive pills. To our knowledge, this is the first case of plantar vein thrombosis diagnosed initially by MRI. Moreover, this case suggests that plantar vein thrombosis should be considered in patients with hypercoagulable states and plantar foot pain. Keywords MRI . Plantar foot pain . Venous thrombosis
Introduction Plantar vein thrombosis is a rare cause of foot pain, with only a few reported cases in the literature [1–4]. Predisposing conditions include recent surgery, trauma, paraneoplastic conditions, and anticardiolipin antibody syndrome [1–4]. Previously reported cases of plantar vein thrombosis D. S. Siegal : J. S. Wu (*) : D. D. Brennan : M. G. Hochman Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue - E/CC 426, Boston, MA 02215, USA e-mail: [email protected] T. Challies Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
have been diagnosed with ultrasound [1–4]. We describe a case of isolated plantar vein thrombosis in a 32-year-old woman with a hypercoagulable state diagnosed by MRI, and describe the associated imaging findings.
Case report A 32-year-old woman presented with a 1-week history of pain along the dorsum, lateral, and plantar aspects of her right foot. She was an active athlete, running 30 miles per week, in addition to participating in other cross-training activities. She had no history of foot trauma, and no prior history of similar symptoms. The patient used oral contraceptive pills, primarily for treatment of endometriosis. She was known to have the prothrombin gene mutation, which was incidentally discovered while volunteering as a control in a laboratory, but had no prior history of thromboembolic events. After 1 week of limited activity, the pain did not resolve, and she became unable to bear weight on her right foot. Physical exam was notable for tenderness and prominent swelling along both the plantar and dorsal aspects of the foot. Initial radiographs were unremarkable. Because of persistent pain, she underwent MRI examination of the foot for investigation of occult stress fracture or infectious process causing swelling. Magnetic resonance imaging performed with and without intravenous gadolinium revealed
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