A multi-disciplinary approach to the management of intra-venous and intra-cardiac leiomymatosis: A case report | [Journal of Pakistan Medical Association • 2022]

Author(s):

1. Azam Jan: Department of Cardio-Thoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan

2. Nabil Iftikhar Awan: Department of Histopathology, Rehman Medical Institute,Peshawar,Pakistan

3. Hira Bakhtiar: Department of Histopathology, Rehman Medical Institute,Peshawar,Pakistan

4. Zahra Ahmad: Department of Cardio-Thoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan

5. Shahid Hasnain: Department of Histopathology, Rehman Medical Institute,Peshawar,Pakistan

6. Syed Mumtaz Anwar Shah: Department of Cardio-Thoracic Surgery, Rehman Medical Institute, Peshawar, Pakistan

Abstract:

We herein report a rare presentation of leiomyoma in a 46-year-old female who presented with complaints of shortness of breath on exertion associated with palpitations for the past one year with a history of irregular menstrual bleeding. Ultrasonography of the abdomen and pelvis revealed an enlarged, distorted uterus with multiple intramural fibroids. A trans-thoracic echocardiography was then performed which showed a large right atrial mass. To investigate further, a contrast enhanced computed tomography was performed covering entire chest and upper abdomen. It showed a large lesion in the right atrium of the heart measuring 6x5cm. The lesion appeared hypo dense and was abutting the tricuspid valve and posterior wall of the Right Atrium. It revealed the Right Atrial lesion extending into the Inferior Vena Cava and lower down into the Common Iliac Confluence, Left Common Iliac and External Iliac Veins. A multi-disciplinary approach was undertaken; the patient underwent a single stage procedure involving a total abdominal hysterectomy with bilateral SalpingoOophorectomy followed by excision of the intra-cardiac tumour. Recovery was uneventful and the patient was successfully discharged on the 5th post-operative day. Due to the lack of literature and low incidence of this disease, this case report presents a rare opportunity to define management guidelines for such occurrences in the future.

Page(s): 1214-1217

DOI: DOI not available

Published: Journal: Journal of Pakistan Medical Association, Volume: 72, Issue: 6, Year: 2022

Keywords:

Intravenous Leiomyomatosis , Leiomyomatosis , Intracardiac Leiomyomatosis

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