“Uterus in My Lung?!” A Case of Pulmonary Leiomyomatosis as a Presentation of Uterine Intravenous Leiomyomatosis

Objective To examine the association between delay of antibiotic treatment and 28‐day mortality in a study of septic patients identified by the Sepsis‐3 criteria. Methods A prospective observational cohort study of patients (≥ 18 years) with sepsis admitted to a Danish emergency department between October 2017 and March 2018. The interval between arrival to the ED and first delivery of antibiotics was used as time to antibiotic treatment (TTA). Logistic regression was used in the analysis of the association between TTA and mortality adjusted for potential confounding. Results A total of 590 patients, median age 74.2 years, were included. Overall 28‐day mortality was 14.6% (95% confidence interval [CI], 11.8–17.7). Median TTA was 4.7 hours (interquartile range 2.7–8.1). The mortality in patients with TTA ≤1 hour was 26.5% (95% CI, 12.8–44.4), and 15.3% (95% CI, 9.8–22.5), 10.5% (95% CI, 6.6–15.8), and 12.8 (95% CI, 7.3–20.1) in the timespans 1–3, 3—6, and 6–9 hours, respectively, and 18.8% (95% CI, 12.0–27.2) in patients with TTA >9 hours. With patients with lowest mortality (TTA timespan 3–6 hours) as reference, the adjusted odds ratio of mortality was 4.53 (95% CI, 1.67–3.37) in patients with TTA ≤1 hour, 1.67 (95% CI, 0.83–3.37) in TTA timespan 1–3 hours, 1.17 (95% CI, 0.56–2.49) in timespan 6–9 hours, and 1.91 (95% CI, 0.96–3.85) in patient with TTA >9 hours. Conclusions The adjusted odds of 28‐day mortality were lowest in emergency department (ED) patients with sepsis who received antibiotics between 1 and 9 hours and highest in patients treated within 1 and >9 hours after admission to the ED.

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Time to administration of antibiotics and mortality in sepsis

Siewers

Abdullah

Sørensen

et al. 2021

JACEP Open

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Ultrasound appearance of intravenous leiomyomatosis

Wang

et al. 2019

Medicine

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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.

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Pulmonary Benign Metastasizing Leiomyoma in a Postmenopausal Woman: A Case Report and Review of the Literature

Piórek,

Płużański,

Wiśniewski

et al. 2024

Diseases

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Pulmonary benign metastasizing leiomyoma (PBML) is a rare condition characterized by the spread of uterine leiomyomas to the lungs, typically observed in premenopausal women with a history of hysterectomy or myomectomy. This report presents a unique case of a postmenopausal woman, aged 65, that emphasizes the clinical, radiological, histologic, and immunohistochemical aspects of the disease. On presentation, the patient suffered from severe pain. On imaging, a sizable lung tumor was found. Histopathological examination and immunoprofiling confirmed PBML. The patient underwent various treatments, including surgery, radiation therapy, and hormonal therapy, illustrating the challenges in managing PBML. A literature review underscores the rarity of PBML and its diverse clinical manifestations. This study provides valuable insights into the complexities of PBML.

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“Uterus in My Lung?!” A Case of Pulmonary Leiomyomatosis as a Presentation of Uterine Intravenous Leiomyomatosis

Cited by 3 publications

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Time to administration of antibiotics and mortality in sepsis

Time to administration of antibiotics and mortality in sepsis

Ultrasound appearance of intravenous leiomyomatosis

Pulmonary Benign Metastasizing Leiomyoma in a Postmenopausal Woman: A Case Report and Review of the Literature

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