Pediatr Emerg Med J.  2021 Dec;8(2):120-123. 10.22470/pemj.2021.00367.

A case of desmoid tumor-induced external iliac vein compression misidentified as deep vein thrombosis

• Koh CY

• KMID: 2524007
• DOI: http://doi.org/10.22470/pemj.2021.00367

Abstract

Desmoid tumor, also known as desmoid-type fibromatosis, is a rare, intermediate, locally aggressive tumor with a high possibility of local infiltration and recurrence, potentially leading to life-threatening problems. We report a case of a 15-year-old girl who visited the emergency department with a 1-week history of the left leg swelling. A point-of-care ultrasound on the leg showed dilated left femoral and popliteal veins. Subsequently, a computed tomography venogram demonstrated a large pelvic mass compressing the left external iliac vein. She underwent tumor resection, and was uneventfully discharged on day 12.

Keyword

Fibromatosis, Aggressive; Iliac Vein; Iliac Vein Compression Syndrome; Ultrasonography; Venous Thrombosis

Figure

• 

  Fig. 1. Initial plain radiographs. No abnormality was noted in the chest (A), and anterior-posterior (B) and lateral (C) views of the left femur.

• 

  Fig. 2. Findings of computed tomography venogram. It shows both hydronephroses (arrows) and left urinoma (asterisk) (A). It also shows a 21 × 14 × 13 cm-sized, pelvic mass with the collapsed and displaced bladder (asterisk) and compressed left external iliac vein without a sign of thrombosis (arrow) (B).

• 

  Fig. 3. Computed tomography on day 8. It shows improvement in both hydronephroses (arrows) and left urinoma (asterisk) (A), and disappearance of the mass with the normally visualized bladder (asterisk) and left external iliac vein (arrow) (B).

Reference

References

1. Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998; 158:585–93.

2. Kline JA, O'Malley PM, Tayal VS, Snead GR, Mitchell AM. Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity. Ann Emerg Med. 2008; 52:437–45.

3. Zitek T, Baydoun J, Yepez S, Forred W, Slattery DE. Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis. West J Emerg Med. 2016; 17:201–8.

4. McFarlane J. Clinical reports of the surgical practice of the Glasgow Royal Infirmary. Med Chir Rev. 1833; 18:126–35.

5. Kasper B, Ströbel P, Hohenberger P. Desmoid tumors: clinical features and treatment options for advanced disease. Oncologist. 2011; 16:682–93.

6. Posner MC, Shiu MH, Newsome JL, Hajdu SI, Gaynor JJ, Brennan MF. The desmoid tumor. Not a benign disease. Arch Surg. 1989; 124:191–96.

7. Garcia-Ortega DY, Martín-Tellez KS, Cuellar-Hubbe M, Martínez-Said H, Álvarez-Cano A, Brener-Chaoul M, et al. Desmoid-type fibromatosis. Cancers (Basel). 2020; 12:1851.

8. Ganeshan D, Amini B, Nikolaidis P, Assing M, Vikram R. Current update on desmoid fibromatosis. J Comput Assist Tomogr. 2019; 43:29–38.

9. Buitendijk S, van de Ven CP, Dumans TG, den Hollander JC, Nowak PJ, Tissing WJ, et al. Pediatric aggressive fibromatosis: a retrospective analysis of 13 patients and review of literature. Cancer. 2005; 104:1090–9.

10. Abdalla S, Wilkinson M, Wilsher M, Uzkalnis A. An atypical presentation of small bowel obstruction and perforation secondary to sporadic synchronous intra-abdominal desmoid tumours. Int J Surg Case Rep. 2016; 20:147–50.

11. Campos FG, Martinez CA, Novaes M, Nahas SC, Cecconello I. Desmoid tumors: clinical features and outcome of an unpredictable and challenging manifestation of familial adenomatous polyposis. Fam Cancer. 2015; 14:211–9.

12. Wang YF, Guo W, Sun KK, Yang RL, Tang XD, Ji T, et al. Postoperative recurrence of desmoid tumors: clinical and pathological perspectives. World J Surg Oncol. 2015; 13:26.