SHM Converge Scientific Abstract ePoster Gallery-Oh Leiomyoma, Don't Break My Heart: Intravascular and Cardiac Invasion

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This case report describes a rare instance of intravenous and intracardiac leiomyomatosis (IVL/ICL), benign smooth muscle tumors that can extend from the uterus into veins and sometimes the heart. Fewer than 400 cases have been reported. Most patients present in their 50s with symptoms such as dyspnea, leg swelling, syncope, or palpitations.<br /><br />The patient was a 51-year-old woman with a history of uterine cysts and mitral valve prolapse who was found on echocardiogram to have a possible right atrial and inferior vena cava (IVC) mass/clot. Imaging studies, including CT, MRI, PET, intravascular ultrasound, and cardiac MRI, suggested a lobulated, enhancing, cystic structure extending from the gonadal vein through the IVC to the right atrium. The main diagnostic challenge was distinguishing tumor from thrombus, which affected management. She was initially treated with heparin and later underwent multidisciplinary evaluation, but surgery was deferred for six months because of concern for clot. She ultimately sought a second opinion at another institution.<br /><br />The report emphasizes Ma’s staging system for IVL: stage I confined to the pelvis, stage II extending into the iliac vein/IVC, stage III reaching above the renal veins and possibly the right atrium/ventricle, and stage IV involving the pulmonary artery. This patient was consistent with stage III disease, which carries a higher risk of cardiopulmonary complications.<br /><br />Definitive treatment is surgical resection, often requiring a coordinated multidisciplinary approach and sometimes single-stage or two-stage operations. In the referenced surgical outcome, the tumor was removed en bloc via the IVC, and pathology confirmed leiomyoma with smooth muscle markers (desmin and SMA positive). The authors stress that IVL/ICL should be considered in women with DVT or an enhancing IVC/right atrial mass, especially with a history of uterine leiomyomas or pelvic surgery. Long-term follow-up is important because recurrence can occur.

Asset Subtitle

Yufei Xiang

Meta Tag

Author List Devicka Ojha, Samy Ataya, Yufei Xiang

Category Clinical Vignettes

Concept Intravenous Leiomyomatosis

Concept Intracardiac Leiomyomatosis

Concept Leiomyoma

Concept Uterine Leiomyoma

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization The Ohio State Wexner Medical Center

Presenting Author Yufei Xiang

Track Adult

Keywords

intravenous leiomyomatosis

intracardiac leiomyomatosis

uterine leiomyoma

inferior vena cava mass

right atrial mass

Ma staging system

smooth muscle tumor

thrombus differential diagnosis

multidisciplinary surgery

cardiopulmonary complications

Intravenous Leiomyomatosis

Intracardiac Leiomyomatosis

Leiomyoma

Uterine Leiomyoma

Echocardiography