Case series of seven women with uterine fibroids associated with venous thromboembolism and chronic thromboembolic disease

Abstract

Uterine fibroids have been described as an associate to acute venous thromboembolism (VTE), with case reports showing an association between large uterine fibroids, acute deep venous thrombosis (DVT), and acute pulmonary embolism (PE). However, there is little known about the association or causation between uterine fibroids, chronic thromboembolic disease (CTED), and chronic thromboembolic pulmonary hypertension (CTEPH). We report on six women with uterine fibroids and CTEPH, as well as one woman with CTED, all of whom presented with exertional dyspnea, lower extremity swelling, and in the cases of CTEPH, clinical, echocardiographic, and hemodynamic evidence of pulmonary hypertension and right heart failure. Compression of the pelvic veins by fibroids was directly observed with invasive venography or contrast-enhanced computed tomography in five cases. All seven women underwent pulmonary thromboendarterectomy (PTE) followed by marked improvement in functional, clinical, and hemodynamic status.

Keywords: chronic thromboembolic pulmonary hypertension; pulmonary thromboendarterectomy; right ventricle function and dysfunction; uterine fibroid; venous thromboembolism.

Fig. 1.

Invasive venograms of iliocaval venous system. (a) Pre- and post-hysterectomy venogram for case 1, obstruction of the IVC. (b) Pre-hysterectomy venogram for case 2, compression of right external iliac vein. (c) Pre-hysterectomy venogram for case 3, compression of right and left external iliac veins. *Arrows identifying pelvic venous compression.

Fig. 2.

Radiologic evidence and surgical specimen. (a) Case 1, CT of the abdomen and pelvis. (b) Case 1, surgical fibroid specimen. (c) Case 4, MRI of the pelvis, compression of the left common iliac vein. (d) Case 5, CT of the abdomen and pelvis, compression of the left common iliac vein.