Inguinal pain and fullness due to an intravascular leiomyoma in the external iliac vein

Abstract

Intravascular leiomyomatosis (IVL) is a benign smooth muscle tumor that evolves from the pelvic veins and can spread to the central veins and heart. Cardiac involvement is the most commonly reported presentation. Initial diagnosis is difficult, and IVL is commonly misdiagnosed as thrombus or atrial myxoma. Appropriate imaging and a high clinical suspicion are required for accurate diagnosis. We report a rare case of IVL in the external iliac vein that recurred 4 years after hysterectomy. Only four cases have been reported in the literature to involve the external iliac vein as it has no direct connection to pelvic venous drainage.

Natural history of leiomyomas beyond the uterus

“…The venous way of proliferation is supported by the fact that in our case, as in other cases, [10,18] leiomyomas spread unilaterally, that is, left-sided. There are reports in which the extension pathway occurred through the right ovarian vein [8,10,19–21] or bilaterally.…”

Surgical management of intravascular leiomyomatosis

“… 1 Once the IVC is reached, the pathology can spread to the right atrium (intracardiac leiomyomatosis), sometimes leading to heart failure and even death if left untreated. 2 The rarity of the IVL, as well as its fairly broad and variable clinical presentation, can easily lead to misdiagnosis 3 and delayed surgical resection of the tumor mass. 4 In this report, we describe the case of a patient presenting with IVL extending from the right ovarian veins up to the right heart and underwent a successful surgical excision.…”