Intravenous leiomyomatosis of the uterus with extension to the right heart

Abstract

A 42-year-old woman admitted with debilitation and engorgement both lower extremities. Transthoracic two-dimensional echocardiography, abdominal ultrasound and computerized tomography revealed a lobulated pelvic mass, a mass within right internal iliac vein, both common iliac vein, as well as the inferior vena cava, extending into the right atrium. In addition, echocardiography and abdominal ultrasound showed the tumor of right atrium and inferior vena cave has no stalk and has well-demarcated borders with the wall of right atrium and inferior vena cave. Hence, the presumptive diagnosis of IVL was made by echocardiography and abdominal ultrasound and the presumptive diagnosis of sarcoma with invasion in right internal iliac vein, both common iliac vein, the inferior vena cava, as well as the right atrium was made by multi-detector-row computerized tomography. The patient underwent a one-stage combined multidisciplinary thoraco-abdominal operation under general anaesthetic. Subsequently the pathologic report confirmed IVL.

Figure 1

Apical four chamber view showing right atrium filled with a medium echogenic oval tumor mass by transthoracic two-dimensional echocardiography. RV: right ventricle, RA: right atrium, LV: left ventricle, LA: left atrium.

Figure 2

Under-ensisternum view showing mass originated from inferior vena cave, extended into right atrium and that mass of right atrium and inferior vena cave has no stalk and has well-demarcated borders with the wall of right atrium and inferior vena cave by transthoracic two-dimensional echocardiography. RA: right atrium, IVC: inferior vena cave.

Figure 3

Pelvic view showing a pelvic mass and continued medium echogenic oval tumor mass within right internal iliac vein, right common iliac vein by abdominal ultrasound. RIIV: right internal iliac vein, RCIV: right common iliac vein.

Figure 4

Abdominal computerized tomography revealed a low attenuation-filling continued defect within the inferior vena cava. IVC: inferior vena cava.

Figure 5

Pelvic computerized tomography revealed a lobulated pelvic mass, a low attenuation-filling continued defect within right internal iliac vein. RIIV: right internal iliac vein.