Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report.

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.