SHM Converge Scientific Abstract ePoster Gallery-Leiomyosarcoma of the Inferior Vena Cava Presenting as Deep Vein Thrombosis

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This case describes a 58-year-old woman with no significant past medical history who presented with bilateral lower-extremity edema, worse on the right. She was initially treated conservatively with compression stockings, but her symptoms persisted for four months. Ultrasound then revealed a right leg deep vein thrombosis (DVT), and she was started on apixaban. Because anticoagulation did not improve her condition, she was referred for thrombectomy.<br /><br />Before the procedure, imaging unexpectedly showed chronic thrombosis of the inferior vena cava (IVC) extending to the liver, along with a lobulated soft tissue mass near the duodenum. The thrombectomy was cancelled, and the patient was admitted for further evaluation. A biopsy confirmed IVC leiomyosarcoma, a rare malignant tumor arising from smooth muscle cells. She later underwent exploratory laparotomy with retroperitoneal sarcoma excision and complete removal of the IVC tumor thrombus.<br /><br />After surgery, her leg edema resolved, and she began chemotherapy with doxorubicin and dacarbazine.<br /><br />The discussion emphasizes that IVC leiomyosarcoma is extremely rare, with fewer than 300 reported cases. Symptoms can include abdominal or back pain, venous thromboembolism, edema, nephrotic syndrome, or Budd-Chiari syndrome. Diagnosis is typically made through abdominal imaging followed by biopsy, and treatment usually involves surgical resection, sometimes with radiation or chemotherapy. Prognosis is generally poor.<br /><br />The key message is that IVC leiomyosarcoma should be considered in patients with persistent lower-extremity edema or DVT that does not respond to standard treatment, especially when symptoms remain unexplained.

Asset Subtitle

Adam Z. Horowitz

Meta Tag

Author List Adam Z. Horowitz, Andrew B. Bernstein, Farida Izzi

Category Clinical Vignettes

Concept Inferior Vena Cava Leiomyosarcoma

Concept Lower Extremity Edema

Concept Deep Vein Thrombosis

Concept Surgical Excision

Concept Edema

Distinguished Non-Finalist

Presenter Organization George Washington University Hospital

Presenting Author Adam Z. Horowitz

Track Adult

Keywords

inferior vena cava leiomyosarcoma

deep vein thrombosis

lower-extremity edema

venous thromboembolism

abdominal imaging

biopsy

retroperitoneal sarcoma

surgical resection

chemotherapy

apixaban

Inferior Vena Cava Leiomyosarcoma

Lower Extremity Edema

Deep Vein Thrombosis

Surgical Excision

Edema