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 the location of the tumour, involvement of adjacent vessels and extension into the right atrium.1

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Figure 1

(A) Ultrasonography image demonstrating heterogeneous echogenic mass within the inferior vena cava (IVC). Contrast-enhanced (B) axial (approximately 91.8 × 83.6 mm) and (C) coronal computed tomography (252.2 × 81.3 mm) images show a low attenuating mass within the IVC. A polypoid-enhancing portion is noted within the mass (arrows). The sarcomatous component is highly suspicious under the image below. The operative histology was reported as high-grade leiomyosarcoma in the IVC.

Physicians should take a careful look at the vessels during emergency sonographic evaluation and any abnormalities implying a complicated lesion requires an immediate computed tomography evaluation.