Extract

A 43-year-old female was admitted with a 10-day history of abdominal distension. She had a history of gravida 1, para 1 (G1P1), with no known history of uterine fibroids. Transthoracic echocardiography revealed a large hypoechoic mass (46 mm × 41 mm) in the right atrium (Panel A; Supplementary data online, Video S1), extending into the dilated inferior vena cava (29 mm). Abdominal computed tomography (CT) angiography showed an irregular mass extending from the right iliac veins into the inferior vena cava and right atrium, with partial tricuspid valve crossing during systole and heterogeneous enhancement (Panels B–E; Supplementary data online, Video S2). A large, heterogeneous mass (150 mm × 65 mm) was also seen in the right adnexa. These findings confirmed intravenous leiomyomatosis (IVL) with intracardiac extension.

After multidisciplinary discussion, the patient underwent hysterectomy and right salpingo-oophorectomy, with postoperative histopathology confirming the imaging diagnosis (Panels F and G). The postoperative course was uneventful, and the patient was discharged 2 weeks later with no tumour recurrence over 4 years of follow-up.

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