Figure 1
CECT coronal reformatted image of abdomen
CECT coronal reformatted image of abdomen reveals an inhomogenously enhancing lesion in midlle and lower segment of IVC with bland thrombus at its cranial end.
IVC leiomyosarcoma
SectionCardiovascular
Case TypeClinical Cases
AuthorsDr. Yama Patel1, Dr. Suvinay Saxena2, Dr. Shikha Khandelwal3
Connected authors
65 years, female
Clinical History
The patient presented with complaints of breathlessness for the past 4 days.
Imaging Findings
An inhomogeneously enhancing soft tissue density lesion is seen involving the middle and lower segments of IVC with minimal extraluminal spread. The lesion is seen minimally protruding into both renal veins. No evident invasion of adjacent structures is seen. Bland thrombus is seen at the cranial end of the lesion in the intrahepatic portion of IVC. CT thorax reveals multiple well-defined soft tissue density nodular lesions of variable sizes in both lung fields suggestive of metastatic deposits.
Discussion
Primary vascular leiomyosarcoma is a rare tumour arising from smooth muscle of media. [1] IVC is involved most commonly. It has significant preponderance for women. [2] The slow-growing tumour process leads to presentation in late stage with systemic metastases.
Presenting symptoms and resectability depend on the location, extension of the tumour and associated thrombosis. So, IVC is divided into three segments: lower (below renal veins), middle (between renal veins and hepatic vein) and upper (from hepatic veins to right atrium). Most of the leiomyosarcomas of IVC involve the middle segment.
Haematogenous spread of the tumour occurs to liver, lung and brain. Lymphatic spread occurs late in the disease process. [2, 3, 4]
USG appearance: A right-sided lobulated hypoechoic retroperitoneal mass, sometimes surrounded by a hyperechoic rim.
CT: Better delineation of the position of the intravascular tumour and its extraluminal spread. The lesion appears large-lobulated and occasionally heterogeneous to haemorrhage and necrosis. The tumour is usually hypovascular, but sometimes may show peripheral enhancement after contrast injection. [5, 6] It is difficult to differentiate retroperitoneal tumours compressing or invading the IVC from extravascular leiomyosarcomas. [7]
Presenting symptoms and resectability depend on the location, extension of the tumour and associated thrombosis. So, IVC is divided into three segments: lower (below renal veins), middle (between renal veins and hepatic vein) and upper (from hepatic veins to right atrium). Most of the leiomyosarcomas of IVC involve the middle segment.
Haematogenous spread of the tumour occurs to liver, lung and brain. Lymphatic spread occurs late in the disease process. [2, 3, 4]
USG appearance: A right-sided lobulated hypoechoic retroperitoneal mass, sometimes surrounded by a hyperechoic rim.
CT: Better delineation of the position of the intravascular tumour and its extraluminal spread. The lesion appears large-lobulated and occasionally heterogeneous to haemorrhage and necrosis. The tumour is usually hypovascular, but sometimes may show peripheral enhancement after contrast injection. [5, 6] It is difficult to differentiate retroperitoneal tumours compressing or invading the IVC from extravascular leiomyosarcomas. [7]
Differential Diagnosis List
Inferior vena cava leiomyosarcoma
Angiosarcoma
Tumour thrombus
Bland thrombus
Final Diagnosis
Inferior vena cava leiomyosarcoma
References
[1] Ahluwalia A, Saggar K, Sandhu P, Gupta K. (2002) Primary leiomyosarcoma of inferior vena cava: an unusual entity. Ind J Radiol Imag 12:4:515–516
[2] Van Rooij WJJ, Martens F, Verbeeten B, Dijkstra J. (1988) CT and MR imaging of leiomyosarcoma of the inferior vena cava. J Comput Assit Tomogr 12(3): 415-419 (PMID: 3366953)
[3] Young R, Friedman AC, Hartman DS. (1982) Computed tomography of leiomyosarcoma of inferior vena cava. Radiology 145(1):99-103 (PMID: 7122904)
[4] Van Zanten TEG, Golding RP. (1987) CT and MR demonstration of leiomyosarcoma of inferior vena cava. J Comput Assit Tomogr 11(4): 670-674. (PMID: 3597892)
[5] Cacoub P, Piette JC, Wechsler B (1991) Leiomyosarcoma of inferior vena cava. Medicine 70: 293-306 (PMID: 1921704)
[6] Hemant D, Kranti Kumar R, Amita J, Chawla R, Ranjit N. (2001) Primary leiomyosarcoma of IVC, a rare entity: Imaging features. Australasian Radiol 45(4): 448-451 (PMID: 11903177)
[7] Skooj SJ, Mcleod DG, Stutzman RE, Bloom DA. (1983) Leiomyosarcoma of the inferior vena cava presenting as suprarenal mass. J Urol 130: 760-772 (PMID: 6887412)
Case information
| URL: | https://www.eurorad.org/case/14549 |
| DOI: | 10.1594/EURORAD/CASE.14549 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
CECT coronal reformatted image of abdomen
CECT coronal reformatted image of abdomen showing inhomogenously enhancing lesion in IVC with minimal extension into both renal veins.
Figure 3
CECT axial image
CECT axial image
Figure 4
CT thorax lung window axial image
CT thorax lung window axial image shows multiple parenchymal nodular lesions of variable sizes in both lung fields.
Figure 5
CT thorax lung window coronal reformatted image
CT thorax lung window coronal reformatted image showing multiple pulmonary parenchymal metatstatic deposits.
CECT coronal reformatted image of abdomen
CECT coronal reformatted image of abdomen reveals an inhomogenously enhancing lesion in midlle and lower segment of IVC with bland thrombus at its cranial end.
Gujarat imaging centre, CT department, Ahmedabad, India.
Gujarat imaging centre, CT department, Ahmedabad, India.
CECT coronal reformatted image of abdomen
CECT coronal reformatted image of abdomen showing inhomogenously enhancing lesion in IVC with minimal extension into both renal veins.
Gujarat imaging centre, CT department, Ahmedabad, India
Gujarat imaging centre, CT department, Ahmedabad, India
CECT axial image
CECT axial image
Gujarat imaging centre, CT department, Ahmedabad, India
Gujarat imaging centre, CT department, Ahmedabad, India
CT thorax lung window axial image
CT thorax lung window axial image shows multiple parenchymal nodular lesions of variable sizes in both lung fields.
Gujarat imaging centre, CT department, Ahmedabad, India
Gujarat imaging centre, CT department, Ahmedabad, India
CT thorax lung window coronal reformatted image
CT thorax lung window coronal reformatted image showing multiple pulmonary parenchymal metatstatic deposits.
Gujarat imaging centre, CT department, Ahmedabad, India
Gujarat imaging centre, CT department, Ahmedabad, India