Robotically-Assisted Resection of Leiomyomatosis in the Inferior Vena Cava With Right Atrial and Ventricular Extension

Intravascular leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can extend from the uterine or pelvic veins into the inferior vena cava (IVC) and, in exceptional cases, the right cardiac chambers. Despite its benign histology, it may present with life-threatening cardiovascular complications and often mimics thromboembolic disease, delaying diagnosis. We report on a 47-year-old woman with a history of uterine fibroids who presented with recurrent syncope. Imaging revealed an intraluminal IVC mass extending through the tricuspid valve into the right ventricle, initially presumed to be thrombus. A prior percutaneous suction thrombectomy was nondiagnostic as no tissue could be aspirated from the mass. To establish tissue diagnosis and to potentially relieve obstruction, the mass was approached using a robotic minimally invasive approach from the right chest. Complete intracardiac resection down to the atriocaval junction was achieved, and pathology confirmed intravascular leiomyomatosis. Recovery was uneventful, and subsequent staged abdominal surgery achieved complete tumor removal. At 6 months, she underwent minimally invasive lobectomy for an additional pulmonary lesion, also consistent with IVL, and remains disease-free on follow-up. In conclusion, intravascular leiomyomatosis should be considered in women with intracardiac masses and a history of uterine leiomyomas. A robotically-assisted minimally invasive strategy offers a feasible and less morbid alternative to traditional open approaches for diagnosis and intracardiac tumor resection.