High-output cardiac failure: an unusual manifestation of intravenous leiomyomatosis.

Intravenous leiomyomatosis is a rare uterine neoplasm characterized by nodular or wormlike masses of histologically benign smooth muscle growing within myometrial veins and extending variable distances into the veins of contiguous organs and major pelvic veins. In some cases, there has been extension into the gonadal or iliac veins to the vena cava and right atrium, causing symptoms of congestive heart failure and an eventual fatal outcome. We present a report of the first case in which high-output cardiac failure was caused by the development of arteriovenous shunting within the intravenous component of the tumor that involved the pelvic organs and retroperitoneal and gonadal veins but not the vena cava. Treatment by total abdominal hysterectomy, bilateral oopherectomy, and tumor mass excision from the retroperitoneum was successful.