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Case Reports
. 2022 Feb 27;14(2):e22666.
doi: 10.7759/cureus.22666. eCollection 2022 Feb.

A Case of Syncope Due to Intracardiac Leiomyomatosis

Shrinjaya Thapa  1 , Bipin Ghimire  1 , Paras Thapa  2 , Tucker Billups  1
Affiliations
Case Reports

A Case of Syncope Due to Intracardiac Leiomyomatosis

Shrinjaya Thapa et al. Cureus. .

Abstract

We present a case of a 46-year-old female presenting with syncope. Echocardiography initially showed a right atrial mass. Further evaluation revealed a mass arising from the fundus of the uterus, with a tumor thrombus in the left gonadal vein, extending into the left renal vein and through the inferior vena cava (IVC) into the right heart across the tricuspid valve. She was managed with surgical resection, and postoperative pathology was consistent with intravenous leiomyomatosis (IVL). IVL is a rare uterine smooth muscle cell neoplasm which extends into the venous system. Gynecological tumors are often overlooked in differential diagnosis for atrial masses. A benign tumor like fibroid, in rare circumstances, can extend into the right side of the heart causing dynamic obstruction to outflow tract, thus increasing mortality. The objective of this article is to present such a case and highlight the broad differentials of atrial masses, including IVL.

Keywords: atrial mass; intracardiac leiomyomatosis; intravenous leiomyomatosis; leiomyoma; syncope.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. 2D transthoracic echocardiography
Mobile echogenic structure in the right atrium with trace tricuspid regurgitation.
Figure 2
Figure 2. MRI of the heart with gadolinium
A mobile mass is seen within the right heart, in the right atrium, and the right ventricle. The intra-cardiac portion of the mass measures 5 x 1.8 cm.
Figure 3
Figure 3. Coronal contrast-enhanced CT of the abdomen
Continuous hypodense lesion extending from the left gonadal vein, through the left renal and into the IVC. Hypodensity in the right atrium, shown more clearly in the cardiac MR appears to be a continuation of the lesion.
See this image and copyright information in PMC

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