MRI Features of Intravenous Leiomyomatosis

Intravenous leiomyomatosis is a rare benign uterine smooth muscle tumor with intravascular growth through pelvic veins or lymphatics. A case is reported of a 42-year-old woman with intermittent spotting and progressive abdominal enlargement. Pelvic magnetic resonance imaging showed a heterogeneous myometrial mass with serpiginous extensions along iliac veins. The lesion had high signal on high b-value diffusion-weighted images and high apparent diffusion coefficient values, indicating the absence of diffusion restriction. After surgery, histopathology confirmed the diagnosis of intravenous leiomyomatosis. Teaching point: Recognition of serpiginous intravascular extensions and the absence of diffusion restriction on magnetic resonance imaging should raise suspicion for intravenous leiomyomatosis.