Ultrasound appearance of intravenous leiomyomatosis

Abstract

Rationale:Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign.Patient concerns:A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy.Diagnoses:Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made.Interventions:The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully.Outcomes:Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence.Lessons:The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

“…Due to diversity and complication of IVL, few studies have focused on its ultrasonic manifestation. Conventional ultrasound has many advantages, such as radiation-free, real-time imaging, safety, convenience, and affordability, though it still has limited sensitivity to detect blood flow, especially in tiny blood vessels with low velocity ( 6 , 7 ).Researchers have affirmed the feasibility of ultrasound in IVL diagnosis ( 8 ). However, conventional ultrasound often misdiagnoses IVL as a thrombus and other diseases ( 9 – 11 ).…”

Intravenous leiomyomatosis involving the right heart: Comprehensive evaluation using echocardiography combined with abdominal ultrasonography

“…Ultrasonography reveals a hypoechoic mass in the intrauterine or parauterine region, characterized by multiple bead‐ or worm‐like nodules distributed along the uterine vein, with clear boundaries, and abundant blood flow signals detected on color Doppler flow imaging (CDFI) in IVL confined to the pelvic cavity 12 . A stripe‐like hypoechoic mass parallel to the long axis of the vein is observed in IVL invasion of the IVC; some tumors may show anechoic areas, and the ultrasonographic images appear “loofah‐like” in long‐axis and “honeycomb‐like” in short‐axis sections 13 . The boundary between the tumor and IVC is clear.…”

Point of care ultrasound facilitated diagnosis of right ventricular mass as the etiology of syncope; A case report of intravenous leiomyomatosis

“…Many studies have used transthoracic and transabdominal ultrasound as a supplemental imaging technique to identify intracardiac masses and uterus masses [2 , 5 , 11 , 17 , 20] . Depending on the degree of extension into the heart, ultrasound imaging can elucidate a free-floating echogenic mass within the right atrium in addition to echoic masses within the internal iliac vein and IVC indicative of IVL with intracardiac extension [21] . Importantly, echocardiography can help distinguish between a right atrial myxoma, which is often included in the differential diagnosis, and IVL with intracardiac extension [8] .…”