A case report of intravenous leiomyomatosis extending into the heart

The patient was a 47-year-old woman who underwent total hysterectomy for uterine leiomyoma in 1994. Two years later, intracaval and intravenous tumors were found by ultrasonic cardiography, magnetic resonance imaging, enhanced chest computed tomography, and venography. The patient underwent total removal of these tumors. Pathological findings indicated that these tumors were leiomyomas. After comparing the present findings with those of similar cases in the literature, we concluded that our patient had intravenous leiomyomatosis extending into the heart. Received: May 7, 2001 / Accepted: May 26, 2001     

静脉内平滑肌瘤累及右心、肺动脉1例

<正>1病例资料患者女,44岁。因"发作性晕厥3个月余"于2012年4月23日入院。患者近期5次劳作或休息时突发晕厥,瘫倒在地,伴有意识障碍,数秒后意识自行恢复,晕厥前过程可回忆,于外院行冠状动脉CT见:下腔静脉、右心室、右心房、右心房流出道、右肺动脉多发占位,黏液瘤可     

Echocardiographic characteristics of intravenous leiomyomatosis with intracardiac extension: a single-institution experience

Background: Intravenous leiomyomatosis (IVL) is a rare smooth‐muscle proliferation arising from a uterine myoma and occasionally extending into cardiac chambers. Methods and Results: A series of 10 consecutive patients with histologically and surgically proven intracardiac IVL between 2000 and 2010 in our hospital were reviewed. The echocardiographic features of 10 cases with IVL and extensive spread into the right‐sided cardiac chambers were described for the first time. All patients were female and the mean age was 42 ± 7 years old. The first symptoms of six patients (60%) were exertional dyspnea and palpitation of cardiac origin. Echocardiography showed that all the tumors originated from the inferior vena cava (IVC) and located in cardiac right chambers (70% in right atrium alone, 30% in right ventricle and atrium). Eight masses (80%) were oval, whereas the others (20%) were serpentine, all with well‐demarcated borders and most (70%) with heteroechogenic texture. Five tumors (50%) intermittently prolapsed into right ventricle through the tricuspid valve. Two patients with nodules adhering to the top of the tumors had pulmonary tumorous thromboembolism. Conclusion: Echocardiography is a simple and important technique to diagnose IVL with intracardiac extension. This disease should be considered in a female patient presenting with an extensive mass from IVC with well‐demarcated border in the right‐sided cardiac chambers. (Echocardiography 2011;28:934‐940)     

第26例:临床表现为下肢跛行、左心室占位

<正>患者男性,32岁。因"间歇性跛行4年余,加重1个月"于2011年6月2日入院。患者从2007年初开始行走时自觉右小腿酸痛,休息之后可以缓解,未特殊诊治。2007年2～3月无明显诱因出现左中上腹痛,当地医院诊为"胰腺炎"治疗3～5 d(具体不详),症状好转。此后患者时常出现     

An unusual case of recurrent mass in the right atrium: intravenous leiomyomatosis

Intravenous leiomyomatosis with a cardiac extension is an extremely rare condition. In this report, a case of a 43-year-old female patient is described: she was operated for right atrial mass protruding into the inferior vena cava, which was later diagnosed as leiomyoma. After a 3-year symptom-free period, recurrence of the extension through the inferior vena cava was observed. After abdominal ultrasonographic examination, which revealed bilateral ovarian and retroperitoneal mass, bilateral oopherectomy, retroperitoneal, and right atrial mass excision was done. The retroperitoneal and right atrial mass was reported as leiomyoma. On her last admission, she had complaints of dizziness, abdominal pain, and bilateral leg edema; and right atrial mass extending through the common iliac vein was noted, but the patient did not accept any further treatment modality.     

A different intracardiac mass: retained sponge

We report a case involving a surgical sponge retained following an aortic valve replacement. The surgical sponge was placed into the left ventricle to protect calcified debris from falling down into the left ventricular cavity. However, the sponge was forgotten and left inside the patient. We identified the retained surgical sponge by transesophageal echocardiography, which was performed because of a difficulty in weaning the patient from the cardiopulmonary bypass.     

Three-vessel myocardial bridging: A possible cause of myocardial stunning

The authors report a rare clinical case of myocardial bridging of the three major coronary arteries, which manifested in an unusual way with severe biventricular dysfunction in the context of tachycardia. For the diagnosis, the authors relied on non-invasive multimodality cardiac imaging, including cardiac magnetic resonance, computed tomography angiography and myocardial perfusion scintigraphy. The implementation of targeted medical and neurohormonal therapy resulted in the recovery of ventricular function and clinical improvement.     

Clinicopathologic features and clinical outcomes of intravenous leiomyomatosis of the uterus: A case series

Rationale:Intravenous leiomyomatosis (IVL) is a rare and special type of smooth muscle tumor originating in the uterus. It is classified as a benign disease according to its histological features but shows the behavioral characteristics of a malignant tumor. It is easily misdiagnosed and recurrent. The purpose of this study was to retrospectively analyze clinicopathological data of 25 cases of IVL in order to enhance clinicians’ understanding of this rare disease.Patient concerns:We screened and identified 25 cases of IVL at our hospital from October 2013 to January 2020. Five patients had tumors.Diagnoses:The diagnosis in each case was pathologically confirmed after surgical treatment.Interventions:All patients were managed surgically. Although the surgical procedures were different, the surgical approach was geared towards achieving complete excision. Three patients received hormonal therapy with gonadotropinreleasing hormone agonists after surgery.Outcomes:We retrospectively reviewed all medical records and analyzed the clinicopathologic features and clinical outcomes of this disease as well as the correlations between the clinical features and risk of recurrence. Neither the symptoms nor the preoperative imaging results were suggestive of IVL in any of the cases. Except for two patients who were lost to follow-up, twenty-three patients who were followed up are still alive. Three patients experienced a recurrence.Lessons:The clinical manifestations and ultrasound images of IVL in the early stages are not typical; thus, IVL is easily misdiagnosed as uterine leiomyoma. Radiologists, pathologists, and surgeons should have a thorough understanding of IVL and a high index of vigilance for IVL in clinical practice. Surgery should always be aimed at achieving complete tumor excision. Patients with large lesions (≥7 cm) and lesions extending to the broad ligament may have an increased risk of recurrence. Early detection, diagnosis, and treatment are very important; once the diagnosis is confirmed, regular follow-ups are crucial.     

Hyperechoic mass of the right ventricle in adults: A rare presentation of an intracardiac teratoma

Cardiac teratomas are very rare primary tumors; most are intrapericardial, while a few are intracardiac. Furthermore, most reported intracardiac teratomas are in the pediatric population, with few cases of secondary metastases from testicular teratomas reportedly manifesting in adults. Here, we report a rare case of a mature cystic teratoma in the right ventricle complicated by a bicuspid aortic valve (BAV) in an adult. Echocardiography and enhanced computed tomography (CT) were performed, and the mass was surgically excised. A pathological examination confirmed the diagnosis of a mature cystic teratoma. Meanwhile, mechanical valve replacement of the aortic valve was performed. No tumor recurrence or symptoms occurred in the 2-year follow-up. This is the first report of an adult primary intracardiac teratoma with solid hyperechoic findings on echocardiography and a BAV.     

Acute recoil of Palmaz-Schatz stent: A rare cause of suboptimal stent implantation—report of two cases with intravascular ultrasound findings

It is generally believed that the Palmaz-Schatz stent maintains a strong radial force, preventing stent recoil. However, the capacity to prevent recoil is largely governed by the hardness or resistance of the lesion. We report two cases of “acute Palmaz-Schatz stent recoil,” documented by intravascular ultrasound, and suggest a novel treatment of this unusual problem. © 1996 Wiley-Liss, Inc.     

Ulnar artery aneurysm – A rare cause of mass on wrist

In this article we are going to discuss a patient with ulnar aneurysm due to atherosclerosis which is very rare in the literature. Among its reasons, trauma, infection, peripherial embolism,immunologic reasons, Ehlers-Danlos Syndrome and arteriosclerosis play role, its diagnosis and treatment is important since it can cause ischemia of finger. The diagnosis of peripherial embolism should also be excluded in such cases with physical examination, ultrasound and angiographic tests. For the treatment of ulnar artery aneurysm surgical procedures like resection and reconstruction may be performed.     

A rare cause of cyanosis and polycythemia: anomalous systemic venous connections without associated intracardiac malformations: The blue milkman Story

Polycythemia, cyanosis and clubbing of fingers and toes resultedfrom a complex anomaly of the systemic venous return in a 24year old white milkman. Cine-angiocardiography revealed an undescribedmalformation of the cardinal system: drainage of the lower limbsand kidneys into two symmetrical channels through the azygossystem and venous drainage of the hepatic veins to the leftatrium, without an intra-alrial septal defect. Successful surgicalcorrection of this right-to-left shunt was performed. The embryologicaimplications of this case are discussed.     

Giant pes anserinus bursitis: A rare soft tissue mass of the medial knee

Bursae are small, jelly-like sacs that are located throughout the body, mainly around the shoulder, elbow, hip, knee, and heel in a number over 150. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction. Pes anserinus bursae, despite being clinically frequent, are not visible either by ultrasound (US) or magnetic resonance image (MRI). In some cases, we may observe a small fluid collection. The present case-report demonstrates the full clinical picture of a giant pes anserinus bursae beginning from clinical observation to its final pathology exam.     

Sternoclavicular septic arthritis: A rare but serious complication of subclavian venous catheterization

Summary Sternoclavicular septic arthritis is a rare complication of subclavian venous catheterization. We estimate that septic involvement of this joint may be as common as one in 500 catheterizations. We report two patients with insidious onset of shoulder pain, chest discomfort, low-grade fever and slight but painful swelling of a sternoclavicular joint four weeks following subclavian venous catheterization. Positive blood cultures in the presence of abnormal bone scan and abnormal conventional X-ray examination or computed tomography of the sternoclavicular joint led to the diagnosis of septic arthritis. Both patients responded well to antibiotic treatment. Based on our observations and that reported in the literature, the earliest changes of sternoclavicular septic arthritis may be detected by bone scan while plain X-ray studies and CT become abnormal during advanced stages of this type of arthritis. We would like to alert physicians to this cause of fever and joint pain in patients who previously underwent subclavian venous catheterization.     

A rare cause of acute coronary syndromes in young adults – myeloproliferative neoplasms: A case series

IntroductionAcute coronary syndromes (ACS) mostly occur in patients with traditional risk factors. Especially in young adults without major cardiovascular (CV) risk factors, one of the less common causes of ACS is myeloproliferative neoplasms (MPNs).MethodsWe retrospectively collected data on 11 consecutive patients (nine men, two women, mean age 40.18±8.4 years) with a diagnosis of MPN who presented with ACS. The demographic characteristics of the study population, type of MPN, clinical manifestations, location of myocardial infarction (MI), coronary angiography findings, complete blood count and other related findings, and treatment strategy before and after diagnosis were analyzed.ResultsSix patients were diagnosed with polycythemia vera, four with essential thrombocytosis and one with primary myelofibrosis. A JAK2 mutation was found in nine patients. Mean time to diagnosis of MPN was 2.81 years after presenting ACS and mean age at first MI was 32.9±6 years. Six patients had no major CV risk factors. Ten patients had anterior MI and one had inferior MI. After initiation of specific treatment for MPN, no recurrent thrombotic events were observed in a mean follow-up of 4±2.44 years.ConclusionsIn young adults presenting with ACS, MPNs should be considered, especially in the absence of atherosclerotic coronary artery lesions. It is also important to pay attention to blood cell count abnormalities seen in intracoronary thrombotic events. Early diagnosis and treatment of MPNs is essential to prevent recurrence of thrombotic events and may reduce mortality and morbidity related to thrombotic complications.