Re: Pelvic Varices, Questionable Thrombus, more likely tumor
From: art fougner, md (evsono@pipeline.com)
Wed Dec 24 05:15:31 2008
Two case reports of pelvic venous thrombosis in the White Journal were
abstracted as poster presentations in 2000. In both cases, the thrombi
were described as "elongated echogenic structures with the veins" and
transversely, as "free round structures within the lumen."
The sonographic diagnosis of uterine venous plexus thrombosis made by
transvaginal B-mode and color Doppler scanning: two case reports
Ultrasound in Obstetrics & Gynecology
Volume 16, Issue s1, Date: October 2000, Pages: 37-37
Z. Leibovitz, S. Degani, I. Shapiro, J. Tal, B. Paz, Z. Levitan,
L. M. Schliamser, A. Toubi, G. Ohel
I'd be inclined to incorporate Jim's suggestions into the work-up as
well as repeat the ultrasound. If tumor search came up negative, I'd
entertain a trial of anticoagulation.
On another note, may everyone enjoy a Merry Christmas and Happy Holidays
and a Healthy and Prosperous 2009.
Art
At Tue, 23 Dec 2008, James Smeltzer wrote:
>
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>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
>
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>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 Extensionand Pulmonary Tumor EmbolismDouglas K. McDonald,1 Sanjeeva P. Kalva,1 Chieh-Min Fan,1 Aleksandr Vasilyev2 Cardiovasc Intervent Radiol (2007) 30:140–142DOI: 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
> confidential and /or proprietary information in the possession of
> WellStar Health System, Inc. ("WellStar") and is intended only for the
> individual or entity to whom addressed. This email may contain
> information that is held to be privileged, confidential and exempt from
> disclosure under applicable law. If the reader of this message is not
> the intended recipient, you are hereby notified that any unauthorized
> access, dissemination, distribution or copying of any information from
> this email is strictly prohibited, and may subject you to criminal
> and/or civil liability. If you have received this email in error, please
> notify the sender by reply email and then delete this email and its
> attachments from your computer.
>- Thank you.
>
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--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
