A 35-year-old patient with a history of progressive dyspnea for one year and a panhysterectomy 8 months before due to extensive uterine myomatosis, evolving with a v-vaginal fistula.
Histopathological study reported leiomyoma with hyaline degeneration and secondary locations in the pelvis and omentum.
Three months prior to transfer, her clinical condition worsened, presenting dyspnea at rest, hypoxemia, hepatomegaly, restlessness, ascites and lower limb edema.
He was diagnosed with thromboembolic disease with pulmonary embolism.
Cavography and pulmonary angiography failed due to the impossibility of advancing through the inferior vena cava (IVC); the echocardiogram revealed a mass occupying the right cavities.
She was referred to our institution.
The patient was admitted with severe cachectica, right heart failure and left lateral decubitus.
Phlebographic study showed obstruction of the iliac veins and IVC, with extensive collateral network draining the azygos system.
Computed axial tomography of the chest, abdomen and pelvis revealed a mass occupying the lumen of the inferior vena cavaari without affecting his heart Budd's wall and pulmonary cavity and the trunk towards the right Chis suprahepatic veins as described in advance syndrome.
1.
We proceeded with surgery in one stage, performing laparotomy and resecting the tumor under cardiopulmonary bypass through the right atrium and abdominal cavotomy.
The tumor was free of adhesion to the venous or cardiac wall, which allowed its complete removal.
IVC was ligated below the renal veins.
The patient developed low output syndrome requiring inotropic support, mechanical ventilation for 20 days and nutritional support.
She required abdominal wound resuture due to an ascitic fistula.
The patient was discharged in good condition after 33 days of evolution.
Biopsy confirmed angioleiomyoma.
1.
At 21 months of follow-up, the patient was in functional capacity I and had regained 28 kg of weight.
Computed axial tomography showed normal cardiac and hepatic image, with no evidence of residual tumor.
Twenty five years after the original surgery, the patient is asymptomatic, with no clinical evidence of recurrence.
A computed axial tomography revealed vena cava permeability.
