title: Intravenous leiomyomatosis with intracardiac extension: an unusual presentation of uterine leiomyoma and evaluation with 256-slice dual-source multidetector CT and cardiac MRI.
abstract: We report a case of a 40-year-old woman who presented with breathlessness, palpitations and vague pelvic pain for 6 months. The dyspnoea was non-exertional and episodic. She was a non-diabetic, non-hypertensive and had no history of prior surgeries. ECG and chest radiograph were normal. Cardiac MRI and 256-slice dual-source multidetector CT evaluation revealed the presence of a uterine and left adnexal mass with intravenous extension into the inferior vena cava via the gonadal veins, and further cephalad extension into the right atrium and ventricle. The patient was referred to the cardiothoracic surgery department and underwent two-stage surgical procedures. The first stage consisted of thoracotomy and tumour removal from the right atrium and inferior vena cava. In the second stage, hysterectomy and bilateral salpingo-oophorectomy was performed. The histological analysis of the excised specimen was consistent with an intravascular leiomyoma.
authors.affiliation: Department of Radiology, GB Pant Hospital, New Delhi, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Jain
authors.affiliation: GB Pant Hospital, New Delhi, India.
authors.forename: Harmeet Kaur
authors.initials: HK
authors.lastname: Rissam
authors.affiliation: Department of Radiodiagnosis, GB Pant Institute of Post Graduate Medical Education and Research (GIPMER), New Delhi, India.
authors.forename: Umesh Kumar
authors.initials: UK
authors.lastname: Mittal
authors.affiliation: Department of Radiodiagnosis, GB Pant Hospital, New Delhi, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000328:Adult; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007044:Hysterectomy; D007090:Image Interpretation, Computer-Assisted; D018231:Leiomyomatosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D061330:Multidetector Computed Tomography; D010052:Ovariectomy; D017699:Pelvic Pain / Q000209:etiology; D012489:Salpingostomy; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014682:Vena Cava, Inferior / Q000473:pathology*