Pulmonary artery embolization of intravenous leiomyomatosis extending into the right atrium

Abstract

A 43-year-old woman was diagnosed with an intravenous leiomyomatosis at a previous hospital and transferred to our hospital to undergo surgical treatment. Emergency one-stage operation for coincidental removal of intra-abdominal, right atrial, and intravenous masses were planned. Upon arriving at the operating room, she suffered a sudden onset of severe dyspnea and showed hemodynamic instability. Intraoperative TEE showed pulmonary embolization of a right atrial mass. Removal of the pulmonary artery mass and the intra-abdominal mass, and the cardiopulmonary bypass were performed without any complications.

Keywords: Embolization; Leiomyomatosis; Pulmonary artery.

Fig. 1

T2-weighted cardiac MRI showing a lobulated mass in the right atrium extended from the inferior vena cava (white arrows). T2-weighted pelvic MRI showing an endometrial mass (black arrow) invading the myometrium and extending into the left pelvic vein (hollow arrow).

Fig. 2

Intraoperative trans-esophageal echocardiogram reveals no previous mass in the right atrium or the inferior vena cava, but a solid mass (white arrow) in the right pulmonary artery. RA=Right atrium; IVC=Inferior vena cava; RPA=Right pulmonary artery; PA=Pulmonary artery.

Fig. 3

Gross findings of the masses removed from the inferior vena cava (A), and from the right pulmonary artery (B).