Magnetic resonance venogram of intravenous leiomyomatosis.

A 47-year-old woman presented with menorrhagia and an enlarged uterus. Uterine fibroids were diagnosed on ultrasound. A few months later, the patient complained of left lower limb swelling. Deep venous thrombosis was diagnosed, anticoagulation therapy was prescribed, and total hysterectomy and bilateral salpingo-oophorectomy were subsequently performed. Pathological examination of the surgical specimen demonstrated intravenous leiomyomatosis. Postoperative computed tomography (CT) scans of the thorax, abdomen, and pelvis were performed to look for evidence of lung secondaries and intravenous extensions of the lesion. Delayed CT after contrast injection showed suspicious heterogeneous enhancement of the infrarenal inferior vena cava (IVC) and left common iliac vein. A magnetic resonance (MR) imaging scan and an MR venogram were then performed to assess the suspected intravenous lesion. On a two-dimensional time-of-flight (TOF) sequence, an abnormal filling defect was revealed in the infrarenal IVC (Fig 1), left common and internal iliac veins (Fig 2). A direct contrast-enhanced MR venogram, using contrast injection via the vascular access at the left foot, revealed the intravenous filling defect and the obstructive effect of the lesion’s collateral formation (Fig 3). The enhancement of the lesion helped to make the diagnosis of an intravenous tumour lesion rather than venous thrombosis. A second operation was performed by a vascular surgeon to excise the tumour from the venous system (Fig 4).