title: Intracardiac leiomyomatosis: clinical findings and detailed echocardiographic features--a Chinese institutional experience.
abstract: BACKGROUND
  Intravenous leiomyomatosis is a rare, benign, smooth muscle tumor originating in the uterus that may extend through the inferior vena cava into the heart. Intracardiac leiomyomatosis (ICL), present in 10% of patients with intravenous leiomyomatosis, may cause right heart failure, tricuspid valve obstruction, and pulmonary embolism. The imaging characteristics of ICL continue to be reported. The purposes of this study were to characterize the echocardiographic features of ICL and to correlate the clinical findings.
  
  
  METHODS
  Between 1999 and 2012, 12 female patients with suspected ICL underwent cardiac surgery and histologic confirmation of the tumor. The clinical data, echocardiographic findings, and histologic results were retrospectively reviewed.
  
  
  RESULTS
  The ages of the patients with ICL ranged from 40 to 59 years. Ten patients (83%) had undergone myomectomy or hysterectomy, one patient had a uterine fibroid, and one patient had endometriosis. Seven patients (58%) reported dyspnea and/or palpitations, and one patient had syncope; four patients were asymptomatic. Echocardiographic findings included six patients with homogenous right atrial masses, four patients with myxoma-like right atrial masses, and two patients with serpentine, convoluted right atrial masses. In nine patients, the right atrial masses were noted to cross the tricuspid valve. All masses extended from the inferior vena cava. No masses appeared to adhere to the right atrium, right ventricular or pulmonary arterial walls, or tricuspid valve. Tricuspid regurgitation was noted in all patients. No pulmonary emboli were present.
  
  
  CONCLUSIONS
  The echocardiographic features of the ICL tumors varied. Tricuspid regurgitation and tumors emerging from the inferior vena cava were seen in all patients. Cardiac symptoms, including dyspnea, palpitations, and syncope, occurred in 67% of patients; the remaining 33% were asymptomatic.
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Gu
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Yihua
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Zhian
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Wenxu
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia. Electronic address: jnixon@mcvh-vcu.edu.
authors.forename: J V Ian
authors.initials: JV
authors.lastname: Nixon
mesh_terms: D000328:Adult; D002681:China; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006338:Heart Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D018231:Leiomyomatosis / Q000150:complications* / Q000000981:diagnostic imaging*; D008875:Middle Aged; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: Cardiac tumor; Echocardiography; Leiomyomatosis