A 19-year-old female patient complained of shortness of breath and syncope, as well as progressive pain and right leg paresthesia for 6 months. She also developed urinary retention, followed by urinary incontinence, as well as difficulty walking.
 
CT scans of the chest, abdomen, and lumbosacral spine revealed a mixed lytic and sclerotic infiltrative lesion in the sacrum, with extensive thrombosis in the iliac veins and foci of calcification in between, extending into the inferior vena cava and finally entering the right atrium. Heterogeneous masses with foci of calcification, consistent with metastases, were also present in the right lower mediastinal region and left lower lobe (Figure 1).
 
Percutaneous biopsy of the sacral lesion revealed a high-grade chondrosarcoma. The patient underwent pelvic radiation therapy and chemotherapy, but the treatment was discontinued because her clinical condition worsened; she died shortly thereafter.
 
Although intravenous leiomyomatosis is the most common cause of neoplastic thrombi extending through the inferior vena cava and reaching the heart, malignant diseases such as leiomyosarcoma, renal carcinoma, adrenal carcinoma, hepatocellular carcinoma, and Wilms tumor can also exhibit this behavior. However, we found no case of a bone tumor showing this particular behavior. (1-3) The case reported herein is of particular interest to pulmonologists because of its clinical presentation (shortness of breath and syncope), as well as the presence of mediastinal metastases.


AUTHOR CONTRIBUTIONS
 
FAFF, JVCMP, and EM: conceptualization, data curation, validation, visualization, writing—original draft, and writing—review and editing. EM: supervision. All authors approved the final version of the manuscript.
 

CONFLICTS OF INTEREST
 
None declared.


REFERENCES
 
1.           Low G, Rouget AC, Crawley C. Case 188: Intravenous leiomyomatosis with intracaval and intracardiac involvement. Radiology. 2012;265(3):971-5. https://doi.org/10.1148/radiol.12111246
2.           Bender LC, Mitsumori LM, Lloyd KA, Stambaugh LE 3rd. AIRP best cases in radiologic-pathologic correlation: intravenous leiomyomatosis. Radiographics. 2011;31(4):1053-1058. https://doi.org/10.1148/rg.314115013
3.           Gehle DB, Morrison ZD, Halepota HF, Kumar A, Gwaltney C, Krasin MJ, et al. Wilms Tumor with Vena Caval Intravascular Extension: A Surgical Perspective. Children (Basel). 2024;11(8):896. https://doi.org/10.3390/children11080896