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Large Uterine Fibroids Causing Mechanical Obstruction of the Inferior Vena Cava and Subsequent Thrombosis: A Case Report

Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio

Joann Lohr, MD, FACS, RVT

Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio

Barry Blum, MD

Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio

Anant Bhati, MD

Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio

Jayapandia Bhaskaran, MD

Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio

Amy Engel, MA

The E. Kenneth Hatton, MD, Institute for Research and Education, Cincinnati, Ohio, amy_engel{at}trihealth.com

A 35-year-old woman presented with severe left leg swelling and pain after a spontaneous abortion of a 20-week fetus. Duplex ultrasound imaging confirmed venous thrombosis of the left iliac, common femoral, superficial femoral, deep femoral, greater saphenous, posterior tibial, and popliteal, peroneal, and soleal veins. A computed tomography scan showed large uterine fibroids that were completely compressing the distal inferior vena cava and both ureters, with associated hydronephrosis. A magnetic resonance venography showed the inferior vena cava proximal to the mechanical obstruction was free of thrombosis but was dilated at 27 mm in the suprarenal location. A hysterectomy was performed and an 8-pound uterus was removed. Intraoperative ultrasound of the inferior vena cava showed a patent crescent shaped vein with no thrombus and adequate venous blood flow. Pathology of the uterus showed a large leiomyoma with necrosis. Her lower extremity symptoms resolved.

Key Words: Uterine fibroids • Leiomyoma • Inferior vena cava obstruction

Vascular and Endovascular Surgery, Vol. 40, No. 5, 425-427 (2006)
DOI: 10.1177/1538574406291333


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