Angioleiomyoma Extending From the Iliac Vein to the Right Atrium

BACKGROUND: Angioleiomyoma is a benign, soft tissue tumor that, depending on its location, can have significant hemodynamic consequences. CASE SUMMARY: A 60-year-old woman with hypertension, hypothyroidism, and breast cancer in remission on tamoxifen presented with dyspnea on exertion and a syncopal episode. Echocardiography and chest computed tomography revealed a mobile right atrial mass that extended into the inferior vena cava and the right common iliac vein. She underwent surgical resection, which removed a 25.5 × 2.3 cm mass confirmed to be angioleiomyoma on histology. DISCUSSION: Angioleiomyoma is a rare, benign tumor classified as a pericytic (perivascular) soft tissue tumor that typically arises in the lower extremities. With infiltration into the inferior vena cava and right heart, hemodynamic limitations may occur, leading to dyspnea and syncope. Primary treatment is surgical resection. TAKE-HOME MESSAGE: Cardiac masses pose a unique challenge in cardiology, often requiring a multifaceted diagnostic approach and tailored therapeutic strategies.