Femoral Vein Leiomyosarcoma Mimicking Thrombosis

Abstract

Background: Leiomyosarcoma represents a diagnostic challenge since it is often misdiagnosed as deep venous thrombosis (DVT).

Methods: A 49-year-old woman with history of DVT and diagnosed with recurrency of thrombosis came to our observation for right thigh pain persistency.

Results: Duplex-Ultrasound (US) examination showed an oval mass inside the superficial femoral vein with color spots and blood flow signal in its context. Contrast enhanced computed tomography and magnetic resonance of the lower limbs showed the presence of vascularized lesion into the distal superficial femoral vein. Echo-guided biopsy revealed the presence of high grade leiomyosarcoma. A total body 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography demonstrated a rounded area of pathological increased FDG uptake, at the distal thigh level without metastatic localization.

Conclusions: Our experience demonstrated that a multimodality approach may help to distinguish leiomyosarcoma from a blood clot in doubtful cases.

Keywords: Leiomyosarcoma; computed tomography; deep venous thrombosis; ultrasound.