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Peer-reviewedCC BY-NC-NDRadiology case reports

Intravenous leiomyomatosis with marked edematous degeneration mimicking IVC thrombus: A case report.

  • Kyohma Wada1,2
  • Sachimi Yamada1,2
  • Akiko Takahata1
  • Ryo Kimura3
  • Wataru Akada2
  • Nana Kozawa2
  • Rika Matsuura2
  • Shiori Umemura4
  • Ayako Nishimura5
  • Kei Yamada1
5 affiliations
  1. 1Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kyoto, Kamigyo-ku, 602-8566, Japan.
  2. 2Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kyoto, Kamigyo-ku, 602-8026, Japan.
  3. 3Department of Radiology, Fukuchiyama City Hospital, 231 Atsunaka-cho, Kyoto, Fukuchiyama, 620-8505, Japan.
  4. 4Department of Obstetrics & Gynecology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kyoto, Kamigyo-ku, 602-8026, Japan.
  5. 5Department of Clinical Pathology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kyoto, Kamigyo-ku, 602-8026, Japan.
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Abstract

Intravenous leiomyomatosis (IVL) is a rare variant of leiomyoma characterized by proliferation of smooth muscle cells within uterine veins, with potential extension into the inferior vena cava (IVC), right atrium, or even pulmonary arteries. In advanced stages, IVL can lead to life-threatening complications, underscoring the need for accurate diagnosis and timely intervention. We report the case of a 40-year-old woman in whom an isoechoic structure within the IVC was incidentally detected on transabdominal ultrasonography and initially suspected to represent an IVC thrombus. Contrast-enhanced computed tomography (CT) demonstrated an enlarged posterior uterine wall with heterogeneous internal enhancement. A filling defect with subtle contrast enhancement within the dilated vessels extended continuously from the uterus through the pelvic venous plexus and right ovarian vein into the IVC. Magnetic resonance imaging (MRI) revealed heterogeneous high-signal-intensity lesions in the uterine myometrium with extension into the pelvic venous plexuses, ovarian veins, and the IVC, findings suggestive of a neoplastic process rather than thrombosis. The patient underwent surgical excision of the intravenous mass in conjunction with hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination confirmed IVL with prominent edematous and degenerative changes. This case highlights the diagnostic difficulty of IVL with marked degeneration, which can closely mimic venous thrombosis, and emphasizes that a continuous pelvic-to-IVC extension, an associated uterine mass, and subtle contrast enhancement should strongly prompt the inclusion of IVL in the differential diagnosis.

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Cite

BibTeXRIS
BibTeX
@article{wada2026intravenous,
  title = {{Intravenous leiomyomatosis with marked edematous degeneration mimicking IVC thrombus: A case report.}},
  author = {Kyohma Wada and Sachimi Yamada and Akiko Takahata and Ryo Kimura and Wataru Akada and Nana Kozawa and Rika Matsuura and Shiori Umemura and Ayako Nishimura and Kei Yamada},
  journal = {Radiology case reports},
  year = {2026},
  month = oct,
  doi = {10.1016/j.radcr.2026.09.062},
  url = {https://europepmc.org/article/MED/42927236},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Intravenous leiomyomatosis with marked edematous degeneration mimicking IVC thrombus: A case report.
AU  - Kyohma Wada
AU  - Sachimi Yamada
AU  - Akiko Takahata
AU  - Ryo Kimura
AU  - Wataru Akada
AU  - Nana Kozawa
AU  - Rika Matsuura
AU  - Shiori Umemura
AU  - Ayako Nishimura
AU  - Kei Yamada
PY  - 2026
DA  - 2026/10/16
JO  - Radiology case reports
DO  - 10.1016/j.radcr.2026.09.062
UR  - https://europepmc.org/article/MED/42927236
AB  - Intravenous leiomyomatosis (IVL) is a rare variant of leiomyoma characterized by proliferation of smooth muscle cells within uterine veins, with potential extension into the inferior vena cava (IVC), right atrium, or even pulmonary arteries. In advanced stages, IVL can lead to life-threatening complications, underscoring the need for accurate diagnosis and timely intervention. We report the case of a 40-year-old woman in whom an isoechoic structure within the IVC was incidentally detected on transabdominal ultrasonography and initially suspected to represent an IVC thrombus. Contrast-enhanced computed tomography (CT) demonstrated an enlarged posterior uterine wall with heterogeneous internal enhancement. A filling defect with subtle contrast enhancement within the dilated vessels extended continuously from the uterus through the pelvic venous plexus and right ovarian vein into the IVC. Magnetic resonance imaging (MRI) revealed heterogeneous high-signal-intensity lesions in the uterine myometrium with extension into the pelvic venous plexuses, ovarian veins, and the IVC, findings suggestive of a neoplastic process rather than thrombosis. The patient underwent surgical excision of the intravenous mass in conjunction with hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination confirmed IVL with prominent edematous and degenerative changes. This case highlights the diagnostic difficulty of IVL with marked degeneration, which can closely mimic venous thrombosis, and emphasizes that a continuous pelvic-to-IVC extension, an associated uterine mass, and subtle contrast enhancement should strongly prompt the inclusion of IVL in the differential diagnosis.
SN  - 1930-0433
ER  -