Subserosal Leiomyoma with Intravenous Leiomyomatosis Extending into Inferior Vena Cava and Right-sided Cardiac Chambers.

Leiomyoma (fibroid) is the most common benign tumour of the uterus in reproductive age. Its treatment is easy and employs a surgical resection, usually without complications. However, it may show an atypical behaviour and result in intravenous leiomyomatosis (IVL) extending into the regional and systemic veins, thus reaching the heart; and may extend into the pulmonary arteries. The symptoms of IVL are non-specific, resulting in underdiagnosis and misdiagnosis of the disease entity and so the condition is underreported. Cross sectional imaging plays an important role in correct diagnosis of the condition, resulting in reduced morbidity and mortality of the patient and saving surgeons from unwanted complications. It typically originates from the uterus and may involve ovarian/uterine veins. We report a 45-year female who presented with right hypochondial pain for which she was diagnosed as cholelithiasis. She was also diagnosed with a left adnexal mass on ultrasonography (USG) for which she underwent a CECT abdomen and pelvis and was diagnosed as a case of subserosal fibroid with IVL extending into left gonadal vein, and inferior vena cava (IVC). Intracardiac extension was confirmed on 2-D echocardiography. This is first reported case of IVL from Balochistan, Pakistan.