Intravenous leiomyomatosis of the inferior vena cava and the right heart atrium. Apropos of a case and review of the literature

• Published in: Annales de chirurgie Vol. 47; no. 3; p. 270
• Main Authors: Alame, A, Solovei, G, Canal, G, Petit, J, Glavier, F, Cart, P, Leflon, M, Karp, P
• Format: Journal Article
• Language: French
• Published: France 1993
• Subjects: Echocardiography; Female; Heart Atria - diagnostic imaging; Heart Atria - pathology; Heart Atria - surgery; Heart Neoplasms - diagnostic imaging; Heart Neoplasms - pathology; Heart Neoplasms - secondary; Heart Neoplasms - surgery; Humans; Leiomyoma - pathology; Leiomyoma - secondary; Leiomyoma - surgery; Middle Aged; Pulmonary Embolism - etiology; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery; Vascular Diseases - etiology; Vascular Diseases - surgery; Vena Cava, Inferior - diagnostic imaging; Vena Cava, Inferior - pathology; Vena Cava, Inferior - surgery
• ISSN: 0003-3944

The authors report a case of intravenous leiomyomatosis, a rare uterine tumor, extending to the inferior vena cava and to the right atrium. It seems to be the first case described in France. The wrong diagnosis of massive pulmonary embolism and the distance from a cardiac surgery unit led to emergency tumorectomy without cardiopulmonary bypass. A review of the literature studied the 24 cases with cardiac extension already reported, 19 operated and 5 autopsy reports. Right cardiac failure or syncopes are the most frequent clinical signs. Sometimes histologic examination after hysterectomy leads to the diagnosis. Echocardiography diagnoses an intra-atrial mass. Abdominal ultrasonography and phlebocavography show the iliocaval portion of the tumor. Cardiac angiography and computed tomography are also contributive. Surgical treatment except in extreme conditions should be performed by a cardiac surgical team. If the diagnosis of intra-venoux leiomyomatosis has been made preoperatively a one-stage cardiac and abdominal treatment should be preferred. In the other cases, cardiac surgery should be done first, allowing a precise histologic diagnosis and subsequent treatment of the iliocaval and uterine lesions.