title: Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report.
abstract: A 35-year-old woman presented with severe left leg swelling and pain after a spontaneous abortion of a 20-week fetus. Duplex ultrasound imaging confirmed venous thrombosis of the left iliac, common femoral, superficial femoral, deep femoral, greater saphenous, posterior tibial, and popliteal, peroneal, and soleal veins. A computed tomography scan showed large uterine fibroids that were completely compressing the distal inferior vena cava and both ureters, with associated hydronephrosis. A magnetic resonance venography showed the inferior vena cava proximal to the mechanical obstruction was free of thrombosis but was dilated at 27 mm in the suprarenal location. A hysterectomy was performed and an 8-pound uterus was removed. Intraoperative ultrasound of the inferior vena cava showed a patent crescent shaped vein with no thrombus and adequate venous blood flow. Pathology of the uterus showed a large leiomyoma with necrosis. Her lower extremity symptoms resolved.
authors.affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Hawes
authors.forename: Joann
authors.initials: J
authors.lastname: Lohr
authors.forename: Barry
authors.initials: B
authors.lastname: Blum
authors.forename: Anant
authors.initials: A
authors.lastname: Bhati
authors.forename: Jayapandia
authors.initials: J
authors.lastname: Bhaskaran
authors.forename: Amy
authors.initials: A
authors.lastname: Engel
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D009336:Necrosis; D010690:Phlebography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology*; D020246:Venous Thrombosis / Q000209:etiology*