Intravenous Leiomyomatosis Involving the Inferior Vena Cava and Right Atrium with Postoperative Pulmonary Embolism: A Case Report

Yukai CHEN^1,2,3Wangwei Zhang⁴Zhuang Aobo^1,2,3Jiaqing Liu^2,5Qinlei Wang^1,2Xiaogang Xia^1,2,3*Wengang Li^1,2,3*

• ¹Xiamen University Cancer Research Center, Xiamen, China
• ²Xiamen University School of Medicine, Xiamen, China
• ³Xiang'an Hospital of Xiamen University, Xiamen, China
• ⁴China Medical University, Shenyang, China
• ⁵The First Affiliated Hospital of Xiamen University, Xiamen, China

Intravenous leiomyomatosis (IVL) is a rare form of smooth muscle tumor characterized by benign histopathology, yet it may exhibit malignant biological behavior. There is no exact data on the prevalence of IVL, while studies have reported that 30% to 80% of fibroids cases are accompanied by extrauterine involvement, and 10% to 30% can spread to the heart(1). When it invades the right ventricle, it can lead to symptoms such as palpitations and dyspnea. In severe cases, it may obstruct the tricuspid valve, the right ventricular outflow tract, or the pulmonary artery, potentially resulting in heart failure or sudden death. Due to the lack of distinctive clinical manifestations and the atypical imaging characteristics associated with IVL, misdiagnosis and missed diagnoses are common. Therefore, the early identification of this condition and accurate assessment are especially critical. This paper reviews a case of IVL that invaded the inferior vena cava and right atrium, culminating in the successful surgical excision of the entire tumor through a multidisciplinary approach, alongside a review of relevant literature.