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Pelvic Varices, Questionable Thrombus, more likely tumorFrom: James Smeltzer (James.Smeltzer@wellstar.org)Mon Dec 22 22:47:44 2008
This is a MIME message. If you are reading this text, you may want to consider changing to a mail reader or gateway that understands how to properly handle MIME multipart messages. --=__Part4D655947.0__ Content-Type: text/plain; charset=UTF-8 Content-Transfer-Encoding: quoted-printable How did this turn out was asked in the forum by Art. Was there a d-dimer done or FDP done? Clinical resolution of the "clot" - expected for one this size which did not obstruct - or not? Also it should be considered that most clot is not significantly different in echogenicity from blood - hence the "Non-compressible vein" finding of high sensitivity and specificity for proximal DVT. This leads to the question "If not clot, then what?" An obvious answer is tumor. This needs to be considered. This is common for renal cell carcinoma and has been reported for leiomyosarcoma of the uterus: Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism Douglas K. McDonald,1 Sanjeeva P. Kalva,1 Chieh-Min Fan,1 Aleksandr Vasilyev2 Cardiovasc Intervent Radiol (2007) 30:140–142 DOI: 10.1007/s00270-006-0118-4 Abstract We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism. Another is a teratoma, pleomorphic adenoma, benign leiomyoma - also not suggested by appearance. Also Kaneko & al suggest that intravascular sonography can be helpful in such tumors in the IVC. One suggestion to identify the source or implantation site would be movement with the valsalva maneuver, with observation on sonography. An interesting case and a report of follow-up or work-up would be nice. Jim Smeltzer, MD James S. Smeltzer, MD Consultant, Maternal Fetal Medicine Wellstar Physicians Group 833 Campbell Hill St., Suite 400 Wellstar NW Women's Care Marietta, GA 30060 ________________________________________________ This email and any files transmitted with it may contain
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