Nonthrombotic pulmonary embolism caused by intravenous leiomyomatosis

RATIONALE: Pulmonary embolism is a potentially devastating medical condition. Although deep-vein thrombosis is the most common etiology, a nonthrombotic pulmonary embolism is not uncommon. PATIENT CONCERNS: A 45-year-old woman was admitted to our hospital for progressive effort dyspnea for 3 weeks. DIAGNOSIS: Echocardiography revealed a mobile mass extending from the right atrium to the bilateral proximal pulmonary artery. As the mass was no response to thrombotic therapy, intravenous leiomyomatosis was suspected. Computed tomography (CT) revealed a hypo-attenuated tumor extending from the ovarian vein to the pulmonary artery. INTERVENTIONS: A 1-stage operation for the surgical removal of the tumor, right salpingo-oophorectomy and subtotal hysterectomy were performed. Surgical specimen was identified as uterine leiomyomatosis without malignant transformation. OUTCOMES: The patient was followed- up for 2 years and subsequent CT did not reveal any notable lesions. LESSONS: Nonthrombotic pulmonary embolism is a potentially life-threatening complication. This case indicated intravenous leiomyomatosis should be considered in the differential diagnosis for certain cases. Complete surgical excision was the only curative treatment.