Extensive Iliofemoral Deep Vein Thrombosis Secondary to Uterine Leiomyoma-Induced Iliac Vein Compression: A Case Report

Deep vein thrombosis (DVT) is an acute vascular condition commonly associated with immobility, hypercoagulability, and endothelial injury. We report the case of a 47-year-old woman presenting with progressive left lower extremity swelling and pain, ultimately diagnosed with extensive iliofemoral DVT secondary to extrinsic compression of the left common iliac vein by a markedly enlarged fibroid uterus. The patient was managed with therapeutic anticoagulation, blood transfusion, and intravenous iron therapy, followed by definitive hysterectomy approximately two months later, with guideline-directed perioperative apixaban interruption and resumption without bridging anticoagulation. This case highlights the importance of cross-sectional imaging in identifying pelvic mass effect as an underrecognized cause of extensive unilateral DVT and the need for definitive treatment of the underlying compressive pathology.