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Intravenous leiomyomatosis manifesting as saddle embolism
  1. Alexandra N Murphy,
  2. Danielle Byrne,
  3. Umer Salati and
  4. Leo Lawler
  1. Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
  1. Correspondence to Dr Alexandra N Murphy, alexandramurphy{at}


A 51-year-old, otherwise well woman, presented with progressive severe dyspnoea. CT pulmonary angiogram (CTPA) demonstrated a large filling defect within the right main pulmonary artery with evidence of right heart strain. She was anticoagulated and discharged home; however, was readmitted with progression of symptoms and hypotension within 1 month. Repeat CTPA demonstrated progression of the filling defect. Formal surgical thrombectomy was performed with removal of an unusual cream-coloured, rubber-like material. Histological analysis revealed intravenous leiomyomatosis (IVL). IVL is a rare benign neoplasm, characterised by smooth muscle cell proliferation in vascular structures that can act aggressively. This case describes the workup, recognition and management of IVL.

  • venous thromboembolism
  • radiology (diagnostics)
  • vascular surgery

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  • Contributors All authors provided a substantial contribution to the acquisition and interpretation of data for the work and agree to be accountable for all aspects of the work (US, DB, ANM and LL). ANM: planned the case report, pulled the patient data (bloods, letters and imaging), contacted the patient for consent and wrote initial draft. DB: helped with planning/analysis of the patient results, chose appropriate images, reviewed drafts and revisions, and final approval. US: helped with the planning of the case report, reviewed drafts and revisions, and final approval. Also, assisted in interpreting images. LL: helped with the planning of case report, rewrote drafts and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.