Title : Intravenous leiomyomatosis with right heart extension: Approach to diagnosis and treatment
Abstract:
Intravenous Leiomyomatosis (IVL), also known as benign leiomyoma, is a rare smooth muscle tumor originating from uterine myoma. It extends into uterine and pelvic veins, sometimes reaching the heart. Predominantly affecting premenopausal women with uterine leiomyomas or prior hysterectomy, IVL exhibits aggressive behavior despite its benign histology. A 37-year-old Hispanic female presented with worsening abdominal pain, nausea, and dizziness. Imaging revealed an intraluminal thrombus extending from the left renal vein to the right atrium. A thrombectomy was performed, and pathology showed leiomyomatous changes, leading to a diagnosis of stage IV Intravenous Leiomyomatosis (IVL). Further evaluation revealed a uterine mass, prompting a robotic-assisted total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. IVL, a rare benign tumor, extends into venous structures and can progress to the heart. Diagnosis relies on imaging and histopathological examination. Treatment typically involves complete surgical excision. Our patient’s management included a multidisciplinary
approach with interventional radiology, vascular surgery, and gynecology. Anticoagulation was discontinued post-diagnosis, and retroperitoneal dissection facilitated safer surgical removal. The postoperative course was uneventful, highlighting the importance of early recognition and comprehensive surgical intervention for IVL to prevent life-threatening complications.
