Leiomyosarcoma of the Inferior Vena Cava with Bilateral Renal Vein Involvement

Leiomyosarcoma of the inferior vena cava (IVC) is a rare soft tissue sarcoma. Surgical resection with negative margins provides the best chance of long-term cure. Good quality cross-sectional imaging is imperative for preoperative planning of the need of IVC resection and reconstruction. A 31-year-old lady presented with non-specific abdominal pain. Cross-sectional imaging demonstrated a mass lesion arising in the infra-hepatic IVC causing bilateral renal vein thrombosis with good left renal collateral venous circulation. She underwent en-mass resection of the tumour along with right nephrectomy and retro-hepatic IVC ligation. The left kidney could be preserved after left renal vein ligation because of preservation of the draining collaterals demonstrated on preoperative imaging with the help of intraoperative Doppler. Demonstrable adequate draining collaterals on preoperative imaging could dismiss the need for reconstruction of inferior vena cava below the hepatic cloaca.