(Circulation. 1999;100:2035-2038.)
© 1999 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Intracardiac Extension of Pelvic Leiomyoma
From the Department of Cardiology and the Division of Cardiothoracic and Vascular Surgery, Geisinger Medical Center, Danville, Pa.
Correspondence to Dr Louis A. Nassef, MD, FACC, Department of Cardiology, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822-2160.
A48-year-old woman presented with a pulmonary embolus diagnosed by ventilation-perfusion scan 2 years after removal of a uterine leiomyoma with intravascular extension.
Transthoracic
echocardiography revealed a dilated
inferior vena cava (IVC) containing a mass extending into
the right atrium (RA). Transesophageal
echocardiography showed a large vacuolated tumor
filling the RA (Figure 1
). The IVC was
seen to be dilated and partly obstructed by the tumor, causing
spontaneous echo contrast in the residual lumen due to the low-flow
state (Figure 2).
|
|
The T1-weighted axial MRI images revealed dilatation of the IVC, with
tumor extending from the left iliac vein via the IVC into the
heart (Figure 3). The angiogram showed
neovascularity filling a pelvic mass (tumor vessels, Figure 4) via the left hypogastric artery.
|
|
Sternotomy with right atriotomy and laparotomy confirmed the presence
of a 6-cm pelvic tumor extending into the RA via the IVC (Figure 5). The nonadherent intracardiac portion
of the tumor was removed retrogradely through a longitudinal IVC
incision.
|
Histopathology confirmed the diagnosis of intravascular leiomyoma
(Figure 6).
|
LA indicates left atrium; TV, tricuspid valve; MV, mitral valve; RV, right ventricle; LV, left ventricle; and HV, hepatic vein.
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
This article has been cited by other articles:
 |
|
 |
|
  R. M. Gowda, M. R. Gowda, N. J. Mehta, R. Osborne, R. Bixon, B. C. Vasavada, and T. J. Sacchi Right Atrial Extension of Primary Venous Leiomyosarcoma: Pulmonary Embolism and Budd-Chiari Syndrome at Presentation: A Case Report Angiology, March 1, 2004; 55(2): 213 - 216. [Abstract] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||