title: Diagnostic and surgical issues in emergency presentation of a pelvic leiomyoma in the right heart.
abstract: A computed tomography scan in a 43-year-old woman with a nonsignificant previous medical history demonstrated an inferior caval mass prolapsing through the right atrium and the tricuspid valve. The mass was misdiagnosed as a thrombus-in-transit, and heparin was started. The clinical picture suddenly evolved into cardiogenic shock, and the patient underwent an emergency resection of the intracardiac portion of the mass. Macroscopic and microscopic features were consistent with leiomyoma. In the presence of an inferior caval mass, historical elements and computed tomography imaging that do not corroborate the hypothesis of caval thrombosis should raise the suspicion of intracaval tumor originating from an abdominal or pelvic organ. The preferred treatment strategy is an elective combined thoracic and abdominal resection.
authors.affiliation: Division of Cardiac Surgery, Catholic University, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Luciani
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.forename: Franco
authors.initials: F
authors.lastname: Glieca
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Martinelli
authors.forename: Gianfederico
authors.initials: G
authors.lastname: Possati
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D017548:Echocardiography, Transesophageal; D004630:Emergencies; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D009361:Neoplasm Invasiveness / Q000473:pathology; D012770:Shock, Cardiogenic / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome