Uterineintravenous leiomyomatosis with cardiac involvement

Abstract

Intravenous leiomyomatosis is a histologically benign smooth muscle tumor that arises either by direct extension of a uterine leiomyoma into the adjacent veins or by vascular intimal smooth muscle proliferation. Herein, we report the case of a 60-year-old female who was noted to have suspected cardiac mass on elective echocardiography done electively for abnormal electrocardiographic findings. Computed tomography and cardiac magnetic resonance indicated the presence of an intravenous leiomyoma originating from the uterus and extending to the inferior vena cava and right atrium. The patient was managed with a single-stage surgery involving cardiopulmonary bypass and excision of the right atrial mass, excision of the inferior vena cava tumor thrombus, and total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Keywords: IVC tumor thrombus; Intravenous leiomyomatosis; Right atrial mass; Uterine leiomyoma.

Fig.1

Echocardiogram showed a mobile echogenic mass with perilesional vascularity (arrows) in the right atrium, partially extending through the tricuspid valve into the right ventricle.

Fig. 2

Sequential axial steady-state free precision (SSFP) images from the level of the right atrium/ventricle to the kidneys show a large mass in the right atrium, extending into the inferior vena cava (arrows) and into the right ovarian vein (arrowheads).

Fig. 3 (

A and B) Early (A) and delayed phase (B) postcontrast axial MR images show no early arterial enhancement but heterogeneous delayed enhancement of the mass.

Fig. 4(A)

Coronal and sagittal contrast-enhanced CT of the abdomen and pelvis shows multiple uterine leiomyomas (curved white arrows) and a right adnexal mass (white arrow) that is inseparable from the uterus and contiguous with the expanded right ovarian vein (arrowheads). A right atrial hypodense mass is partially visualized (yellow arrow). (B) Coronal and sagittal curved multiplanar reformation (MPR) images of the abdomen and pelvis show the right adnexal mass (white arrow) extending and expanding the right ovarian vein (arrowheads), inferior vena cava, and the right atrium (yellow arrows). (Color version available online)

Fig. (4B)

Coronal and sagittal curved multiplanar reformation (MPR) images of the abdomen and pelvis show the right adnexal mass (white arrow) extending and expanding the right ovarian vein (arrowheads), inferior vena cava, and the right atrium (yellow arrows).