Intravenous leiomyomatosis: the first reported case of intraoperative intracaval embolisation of tumour to the right atrium

2020 ◽  
Vol 13 (3) ◽  
pp. e233341
Author(s):  
Gillian A Corbett ◽  
Catherine O'Gorman ◽  
Waseem Kamran
Keyword(s):  
Right Atrium ◽  
Uterine Leiomyoma ◽  
Histopathological Examination ◽  
Vena Cava ◽  
Abdominal Distension ◽  
Preoperative Imaging ◽  
Intravenous Leiomyomatosis ◽  
Midline Laparotomy ◽  
First Case ◽  
The Right

Intravenous leiomyomatosis is extremely rare. This case describes a 42-year-old woman who presented with abdominal distension, cyclical bloating and urinary retention. Preoperative imaging showed a multilobulated uterine mass. Following multidisciplinary team discussion, a complete staging surgery consisting of midline laparotomy, total hysterectomy and bilateral salpingo-oophrectomy was performed. Intraoperatively, a large multilobulated uterine mass was noted with engorgement of the infundibulopelvic ligaments due to intravascular extension of tumour. On removal of the uterus, the patient desaturated and became hypotensive. Intraoperative transoesophageal echocardiography revealed mass extending from the inferior vena cava (IVC) into the right atrium (RA). The cardiothoracic surgical team retrieved a worm-like mass extending from the IVC into the RA. Histopathological examination diagnosed a large uterine leiomyoma with intravenous leiomyomatosis. The mass from the RA was a bland spindle cell tumour which matched the uterine mass histopathologically. Intravenous leiomyomatosis is a rare variant of uterine leiomyoma. Although intracardiac extension has been described, this is the first case of intraoperative embolisation of pelvic tumour to the RA at hysterectomy.

scholarly journals P169 Uterine leiomyoma extension into right side cardiac

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Diniz Ferrer ◽  
CARLOS Silveira ◽  
ADRIAN Reis ◽  
PAULA Abreu E Lima ◽  
ROBERT Diniz ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Uterine Leiomyoma ◽  
Inferior Vena ◽  
Tumor Resection ◽  
Vena Cava ◽  
Cardiac Imaging Techniques ◽  
First Case ◽  
Adjacent Structures ◽  
The Right

Abstract Funding Acknowledgements governmental grants Uterine leiomyoma is a commom disease in women, however, intravenous leiomyomatosis of uterine origin extending via inferior vena cava into the right side of the heart,known as intracardiac leiomyomatosis is a rare condition (3%). In 1907, Durk reported the first case of intracardiac extension. The patient was a Woman, 35 years old, admitted to our emergency department for an intracardiac mass. She had shortness of breath,fatigue and chest pain. The transthoracic two dimensional echocardiography showed an echogenic oval mass mobile in right atrium and projected through right ventricle in diastole. This mass was observed to extend from inferior vena cava to the right atrium. The echotransesophageal three dimensional showed a large mobile mass that extended from inferior vena cava to the right atrium. A Computer tomographic (CT) scan showed a hypodense multilobulated mass in the pelvis, which had invaded the inferior vena cava and right atrium. The patient underwent a two stages surgery. In first stage (transatrial tumor resection). The operation was performed normal temperature with establisment of cardiopulmonary bypass (CPB). Subsequently, the pathological report was confirmed uterin smooth muscle origin. The second stage surgery ( total histerectomy) was done four weeks later for removing lobulated mass uterin with dimensions 20x15x7.5cm with confirmed histopathological of leiomyoma. Because of it is nonspecific clinical presentation and rarity, an intracardiac Leiomyomatosis continues to be a misdiagnosed as either thrombus or myxoma. The cardiac imaging techniques like a transthoracic echocardiography 2d and transesophageal echocardiography 3d have been used to define the presence, extension of tumor as appearance of the mass and involvement of adjacent structures. Abstract P169 Figure. Echotransesophageal 3D (bicaval view)

scholarly journals Intravenous Leiomyomatosis with Intracardiac Extension: Echocardiographic Study and Literature Review

2014 ◽  
Vol 41 (5) ◽  
pp. 502-506 ◽  
Author(s):  
Rongjuan Li ◽  
Yanguang Shen ◽  
Yan Sun ◽  
Chuanchen Zhang ◽  
Ya Yang ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Uterine Leiomyoma ◽  
Inferior Vena ◽  
Vena Cava ◽  
Common Disease ◽  
Intravenous Leiomyomatosis ◽  
Endothelial Surface ◽  
The Right ◽  
The Masses

Uterine leiomyomatosis is a common disease in women; however, intravenous leiomyomatosis with intracaval and intracardiac tumor extension is rare. We sought to analyze the clinical and echocardiographic features of intracardiac leiomyomatosis. From January 2003 through July 2012, 7 women (age range, 24–59 yr) underwent surgical resection of histopathologically diagnosed intracardiac leiomyomas at our hospital. Most of the patients had histories of hysterectomy or uterine leiomyoma. We retrospectively analyzed their preoperative echocardiograms. We found that the tumors had no stalks, did not adhere to the wall of the right side of the heart, were highly mobile, and moved back and forth in the right atrium near the tricuspid orifice. All tumors originated from the inferior vena cava and had borders well demarcated from that structure's wall. Most of the masses extended into the inferior vena cava and right atrium through the right internal and common iliac veins. Computed tomograms revealed pelvic tumors and contiguous filling defects in 6 patients. When echocardiograms reveal a right-sided cardiac mass that originates from the inferior vena cava, particularly in women who have a history of hysterectomy or uterine leiomyoma, intracardiac leiomyomatosis should be suspected. If the mass has no stalk and freely moves within the inferior vena cava and right-sided cardiac chambers without attachment to the endothelial surface or endocardium, intracardiac leiomyomatosis should be diagnosed. We discuss our findings and briefly review the relevant medical literature.

scholarly journals Intravenous Leiomyomatosis of the Uterus: A Retrospective Single-Center Study in 14 Cases

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Qingbo Su ◽  
Xiquan Zhang ◽  
Hui Zhang ◽  
Yan Liu ◽  
Zhaoru Dong ◽  
...  
Keyword(s):  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Pelvic Cavity ◽  
Intravenous Leiomyomatosis ◽  
Abdominal Incision ◽  
Imaging Results ◽  
The Right

Purpose. This study aimed to retrospectively review the diagnosis and surgical treatment of uterine intravenous leiomyomatosis (IVL). Methods. The clinical data of 14 patients with uterine IVL admitted to our hospital between 2013 and 2018 were retrospectively analyzed, including their demographics, imaging results, surgical procedures, perioperative complications, and follow-up results. Results. The tumors were confined to the pelvic cavity in 7 patients, 1 into the inferior vena cava, 4 into the right atrium, and 2 into the pulmonary artery (including 1 into the superior vena cava). Only one case was misdiagnosed as right atrial myxoma before the operation, which was found during the surgery and was treated by staging surgery; all the other patients underwent one-stage surgical resection. Three patients underwent complete resection of the right atrial tumor through the abdominal incision, and one patient died of heart failure in the process of resection of heart tumor without abdominal surgery. During the 6–60 months of follow-up, 4 patients developed deep venous thrombosis of the lower extremity, and 1 patient developed ovarian vein thrombosis and pulmonary embolism. After anticoagulation treatment, the symptoms disappeared. One patient refused hysterectomy and the uterine fibroids recurred 4 years after the operation. Conclusion. Specific surgical plans for uterine IVL can be formulated according to cardiac ultrasound and computed tomography (CT). For the first type of tumor involving the right atrium, the right atrium tumor can be completely removed through the abdominal incision alone to avoid thoracotomy. The disease is at high risk of thrombosis and perioperative routine anticoagulation is required.

scholarly journals Invasion of Pheochromocytoma from the Caudal Vena Cava to the Right Ventricular Cavity in a Dog

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Takafumi Machida ◽  
Noboru Machida
Keyword(s):  
Right Ventricular ◽  
Chromaffin Cells ◽  
Vena Cava ◽  
Abdominal Distension ◽  
Video File ◽  
Ventricular Cavity ◽  
First Case ◽  
Adrenal Pheochromocytoma ◽  
Vagal Reflex ◽  
The Right

Pheochromocytomas are catecholamine-secreting tumors that are composed of neuroectoderm-derived chromaffin cells. An 8-year-old miniature dachshund with abdominal distension was diagnosed with a neuroendocrine tumor with invasion from the caudal vena cava to the right ventricular cavity. The dog died due to hypotensive shock from the vagal reflex, and on autopsy, an extra-adrenal pheochromocytoma (paraganglioma) was diagnosed in the caudal abdomen. At autopsy, the tumor plug of the caudal vena cava was confirmed. To the best of our knowledge, this is the first case report that echo-captured the extension of pheochromocytoma in the right ventricle and shows it in a figure and video file.

Venous drainage for minithoracotomy approach in an adult with interrupted inferior vena cava

2021 ◽  
pp. 021849232110170
Author(s):  
Toshitaka Watanabe ◽  
Kazuma Okamoto ◽  
Nobuyuki Yoshitani ◽  
Ryo Tohma ◽  
Takuya Misato ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Septal Defect ◽  
Inferior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Venous Drainage ◽  
Preoperative Imaging ◽  
Atrial Septal Defect Closure ◽  
The Right

For atrial septal defect closure via right minithoracotomy in an adult patient with infra-hepatic interruption of the inferior vena cava with azygos connection, an alternative venous cannulation strategy was applied. In addition to bicaval cannulations to the femoral vein and the internal jugular vein, a 20 Fr straight cannula draining the hepatic vein was added to the proximal IVC through the right atrium wall via a working port. A bloodless operative field in the right atrium was afforded with bicaval encircling. Preoperative imaging test of the continuity of the IVC was important planning cardiac surgery with peripheral cannulations.

scholarly journals Intravenous Leiomyoma with Extension to the Heart: A Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Fuat Demirkiran ◽  
Veysel Sal ◽  
Umit Kaya ◽  
Cem Alhan ◽  
Nedim Tokgozoglu
Keyword(s):  
Uterine Fibroid ◽  
Right Atrium ◽  
Abdominal Cavity ◽  
Vena Cava ◽  
Right Atrial ◽  
Common Iliac Vein ◽  
Intravenous Leiomyomatosis ◽  
Pelvic Masses ◽  
History Of ◽  
The Right

Introduction. Intravenous leiomyomatosis with cardiac extension is an extremely rare uterine tumor. We report here a case of intravenous leiomyoma extending to the right atrium, diagnosed in a patient having leiomyoma.Case Presentation. A 39-year-old woman with no symptoms and a past medical history of two myomectomy operations (7 and 3 years previously) was admitted to our clinic for routine control. We detected a uterine fibroid of 8 centimeters and 4 small solid masses of 1-2 centimeters near the uterus and ovaries at vaginal ultrasonography. Computed tomography (CT) was performed to investigate the abdominal cavity. It revealed a mass originating from the left common iliac vein, which invaded the inferior vena cava (IVC) and extended to the right atrium in addition to the uterine fibroids and pelvic masses. The operation was performed with a combined team of gynecologists and cardiac surgeons and a one-stage operation was accomplished. The postoperative course was uneventful.Conclusion. Abdominal CT is a useful imaging technique for the diagnosis of unusual pathology in a patient with uterine fibroid having suspicious pelvic masses. Also, when a right atrial mass is identified in a female with a prior history of hysterectomy because of leiomyoma or in whom there is a uterine myoma, then intravenous leiomyomatosis should be considered.

scholarly journals Obstruction of the Hepatic Venous Flow Caused by Intravenous Leiomyomatosis

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 696
Author(s):  
Sin-Youl Park ◽  
In Hwan Yeo ◽  
Yun Jeong Kim ◽  
Jong Kun Kim
Keyword(s):  
Early Recognition ◽  
Rare Complication ◽  
Vena Cava ◽  
Pelvic Mass ◽  
Abdominal Distension ◽  
Hepatic Veins ◽  
Intravenous Leiomyomatosis ◽  
Venous Flow ◽  
Bedside Ultrasonography ◽  
The Right

Budd–Chiari syndrome (BCS) is a rare intrahepatic vascular disease that is characterized by a hepatic venous outflow obstruction. Intravenous leiomyomatosis (ILs) is a rare complication of a myoma. Here, we report a case of BCS that was caused by intracaval ILs. A woman presented to the emergency department (ED) with abdominal distension that had gradually progressed over a period of 3 years. Bedside ultrasonography and contrast-enhanced computed tomography (CECT) showed a large ascites and pelvic mass. The mass continued to the inferior vena cava and the right atrium. The intracaval mass was obstructing the left and middle hepatic veins. We established a tentative diagnosis of BCS caused by intracaval ILs and attempted surgical resection. Complete resection of the intracaval mass failed because of adhesion; however, she was discharged from the hospital without any postoperative complications. After 3 months, a pelvic ultrasonography showed a recurrence of a 4 × 3 cm pelvic mass. The mass size increased to 6 cm after 30 months. ILs can cause secondary BCS and can lead to life-threatening conditions. Owing to its extreme rarity, early detection in the ED is challenging. Bedside ultrasonography and CECT can enable the early recognition of BCS by ILs.

scholarly journals P1704 An unusual mass in the right heart

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Wojtkowska ◽  
W Brzozowski ◽  
M Prasal ◽  
S Lukasik ◽  
E Czekajska-Chehab ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Inferior Vena ◽  
Histopathological Examination ◽  
Vena Cava ◽  
Premenopausal Women ◽  
Iliac Vein ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
Benign Tumours ◽  
The Right

Abstract A 39 year old patient after removal of the uterus, the left oviduct and the right appendages due to Tu (massive fibroids). The histopathological examination revealed: leiomyomatosis intravascularis masiva (multifocal, intravenous smooth muscle cell hyperplasia without necrosis, cellular atypia and mitotic activity. Vascular invasion within the uterus, parametrium, mesovarium, perinodule tissues). The patient was admitted to the Gynaecology Clinic on the 9th postoperative day due to pain in the right lumbar region. The angio-CT of the thoracic, abdominal and pelvic cavities revealed a tumour/thrombus in the right internal iliac vein, common iliac vein and inferior vena cava (VCI). Then, the patient underwent transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) revealing an additional mass in the VCI entering the right atrium (RA), periodically passing through the tricuspid valve to the right ventricle (RV). The mass was of irregular shape, free-floating and did not obstruct the right ventricle inflow. Due to a suspicion of thrombus, an attempt at pharmacological treatment was initiated: initially LMWH at a therapeutic dose, followed by UFH iv. (controlled by APTT). Follow-up echocardiography: the image has not changed, the mass is still in the same location. The patient then underwent a surgical treatment: the pathological mass with a length of 35 cm was removed from VCI and RA with extracorporeal circulation. The histopathological examination confirmed: numerous foci of intravenous leiomyomatosis in the form of smooth muscle hyperplasia penetrating into the light of numerous vessels, mainly venous. Discussion Uterine fibroids are the most common benign tumours of the reproductive tract in premenopausal women, they are also the most common cause of hysterectomy. They are formed as a result of benign proliferation of myometrial smooth muscle cells. A special, though very rare, form is intravenous leiomyomatosis (IVL) - caused by abnormal growth of benign tumours, arising from smooth muscle, into venous vessels. Although histopathologically they are benign tumours, due to the possible invasion of large vessels they can be highly "aggressive" and extend into the heart chambers and pulmonary arteries (intracardiac leiomyomatosis - ICLM). Possible symptoms of ICLM: dyspnoea (30-37%), peripheral oedema (20-28%), chest pain (12-30%), palpitation (10-17%), fainting (11%). Approximately 13% of patients have no symptoms at all. In the differential diagnosis of masses in the right heart cavities, the following should be taken into account : thrombus, myxoma, metastases of malignant neoplasms, in particular renal cancer, as well as: liver cancer, adrenal cancer, lymphoma, leiomyosarcoma. Conclusion IVL should be taken into account as a differential diagnosis in case of a free-floating mass in the right heart chambers, originating from the inferior vena cava, among premenopausal women with a history of hysterectomy. Abstract P1704 Figure. mass in the right atrium

scholarly journals Emphysematous pyelonephritis with air bubble in the inferior vena cava

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Tiffany A. Perkins ◽  
Alberic Rogman ◽  
Murali K. Ankem
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Rare Presentation ◽  
Emphysematous Pyelonephritis ◽  
Case Presentation ◽  
Air Bubble ◽  
First Case ◽  
The Right

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

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