Intravascular leiomyomatosis with cardiac and pelvic involvement in a postmenopausal woman: A case report of multidisciplinary team management

Abstract

Intravascular leiomyomatosis (IVL) is a rare benign condition in which a leiomyoma, originating from the uterus, propagates through the pelvic venous system and occasionally extends into the inferior vena cava (IVC), occasionally reaching the heart. Despite its low incidence and benign nature, IVL can lead to life-threatening obstructions in the right heart's outflow tract, potentially resulting in sudden death. In this article, we present a case of a 72-year-old postmenopausal patient with IVL, who initially presented with palpitations. The diagnosis was made through echocardiography and a computerized tomography (CT) scan, revealing a tumor that extended from the uterus through the IVC and into the right ventricle. The patient was managed by a multidisciplinary team of gynecologists and cardiothoracic surgeons, who performed a single-stage surgical removal of a tumor 25 cm long. The pathological report confirmed the diagnosis of IVL. Postoperative follow-up is crucial, as IVL recurs in up to 30% of cases. This article's objective is to provide a clinical illustration of this exceedingly rare condition, with fewer than 300 reported cases, and to offer a comprehensive overview of IVL, including its clinical presentation, diagnosis, treatment, and outcomes.