The first case of contrast-enhanced endoscopic ultrasound with fine needle aspiration for leiomyoma of infrarenal inferior vena cava

OBJECTIVES: This study aims to evaluate endoscopic ultrasound (EUS) ability in detecting and puncturing lesion of inferior vena cava (IVC) located below renal veins. METHODS: A 54-year-old female patient presented with periodic abdominal pain. US and computed tomography (CT) revealed retrocaval lesion, compressing IVC 3 cm below the right renal vein – a big lymph node (28 mm) was suspected. EUS purpose was to differentiate this lesion between lymph node and primary tumor. EUS was performed under endotracheal anesthesia, in the patient's left lateral position, using radial and convex echoendoscopes, ultrasound contrast agent, and 25G needle. RESULTS: Not knowing whether we would be able to reach infrarenal IVC area, we started with radial echoendoscope. EUS revealed a 3 cm oval hypoechoic lesion arising from IVC wall or invasing it, partly pressed into the IVC lumen. Doppler obtained single doubtful signal. Contrast-enhanced EUS showed the arterial phase vascularization. Two fine needle aspirations (FNAs) were done with slim convex echoendoscope during apnea, at active aspiration (with syringe) because of the risk of IVC injury. There were no complications. Cytology excluded lymph node and suspected vascular origin of the tumor. The patient underwent laparoscopic wedge resection of the infrarenal IVC wall containing the tumor with the use of linear stapler. Morphology of surgery specimen detected IVC leiomyoma. CONCLUSION: Contrast-enhanced EUS with FNA showed successful result in preoperative detection of inferior vena cava lesion located below renal veins.