Rare Case of Benign Prostatic Hyperplasia Causing Deep Vein Thrombosis.

62-year-old male with a history of Parkinson's disease presented with worsening left leg pain and swelling for approximately one month. Patient denied any history of immobility, recent travel, malignancy, blood clots, or thrombophilia disorders. Physical exam was remarkable for marked swelling of entire left lower extremity, more pronounced in the thigh (Figure 1a), and massive abdominal distension (Figure 1b). Laboratory work-up showed leukocytosis at 19.0 × 109/L with normal hemoglobin, platelets, and coagulation panel. Duplex ultrasound revealed an extensive deep vein thrombosis extending from the left distal femoral vein through the external iliac vein. Computed tomographic angiographic (CTA) scan of the abdomen and pelvis showed a markedly distended bladder, with the dome of the bladder 24 cm above the pubic symphysis, causing significant mass effect on the distal inferior vena cava (Figure 2a, 2b), and an occluding thrombus in the left common iliac, left external iliac, left internal iliac, and visualized proximal left thigh veins. Patient now endorsed having urinary hesitancy and incomplete bladder emptying for over a year. Treatment was initiated with heparin drip, placement of urethral catheter, and Tamsulosin 0.4 mg daily. After 3 days of treatment, CT urography showed decompression of the urinary bladder with significantly reduced mass effect on the inferior vena cava (Figure 2c, 2d). Patient was eventually diagnosed with benign prostatic hyperplasia and underwent transurethral resection of the prostate several months later. Figure 2a, b CT Angiogram of abdomen/pelvis showing markedly distended bladder with mass effect on IVC. (2c, 2d). CT Urography showing decompression of urinary bladder with reduced mass effect on IVC after treatment. View Large Image Figure Viewer Download Hi-res image