Ultrasound Imaging of Intravenous Leiomyomatosis With Intracardiac Extension

Intravenous leiomyomatosis (IVL) is a rare uterine leiomyoma subtype. In this study, we aimed to explore IVL ultrasound features to improve its recognition and diagnostic accuracy.

We retrospectively analyzed the clinical, ultrasound, and pathological data of four patients diagnosed with IVL via surgery at our hospital between April 2023 and February 2025, assessing lesion morphology, mobility, extension, clinical staging, and enhancement patterns via conventional and contrast-enhanced ultrasound (CEUS).

We included four female patients (age and mean age: 28-50 and 45.25 ± 7.46 years, respectively) in this study. Three patients had a history of uterine leiomyoma. Three and one cases were stage III and IV, respectively. Conventional ultrasound revealed that IVL within the veins appeared as continuous "cord-like" sign or "sieve hole" sign masses with high mobility and no adhesion to the vessel walls. In the cardiac chamber, IVL manifested as "snake head" or "sieve hole" sign masses extending from the inferior vena cava into the right cardiac chambers, moving dynamically with the cardiac cycle. CEUS revealed heterogeneous IVL enhancement, delayed enhancement, and slightly lower enhancement intensity compared to adjacent vascular or cardiac chambers.

IVL ultrasound features displayed continuous "cord-like" or "sieve hole" sign masses with high mobility and no adhesion to the vessel walls. When extending to the heart, IVL manifested as a "snake head" or "sieve hole" sign in the cardiac chamber. Taken together, CEUS examination is helpful for IVL diagnosis.