IMAGES IN EMERGENCY MEDICINE
Diagnostically challenging tumour in a great vessel: leiomyosarcoma of inferior vena cava
1 Ulsan Fire Department Headquarters, Ulsan, Republic of Korea
2 Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
3 Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
4 Department of Emergency Medicine, Changwon Fatima Hospital, Changwon, Republic of Korea
Correspondence to:
Dr J W Park, Department of Emergency Medicine, Changwon Fatima Hospital, 212 Myeongseo-Dong, Changwon 641–560, Republic of Korea; erman@naver.com
Accepted 14 March 2008
| The first 150 words of the full text of this article appear below. |
A 32-year-old women had a 2-week history of abdominal pain with vomiting. She had direct tenderness in the right upper quadrant and epigastric area. There was an ambiguous, non-pulsatile mass.
Although tumour in the great vessels is rare, the inferior vena cava (IVC) is the most common site of origin. Symptoms include vomiting, leg oedema and pain in the epigastric area, right upper quadrant and back. The manifestations can be biliary disease, renal and pulmonary thromboembolism. It can induce cardiac symptoms or arrhythmias if extended into the right atrium. However, the most common presentation is vague abdominal pain of which the clinical significance is easily overlooked.1
Although ultrasound may detect masses, it is difficult to ascertain the origin. If the tumour is not large enough and if physicians do not consider any possible tumour lesions in the vessels, early diagnosis is almost impossible. Contrast-enhanced computed tomography is useful in imaging
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