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Volume 17
Issue 1
Online publication date 2016-07-27
Title Sudden death due to pulmonary thromboembolism in an hypertensive patient with large leiomyomata: A case report and review of relevant literature
Author Ayodele Joshua Omotoso, Martin Anozodo Nnoli, Patience Olufemi Odusolu, Ekpe Lawson, Anthonia Ikpeme, Kenneth Omoruyi, Inemesit Akpan
Abstract
The pathophysiology of venous thrombosis is classically attributed to alterations in one or more components of Virchow’s triad: hypercoagulability, stasis, and damage to the vascular endothelium. Deep vein thrombosis (DVT) may lead to pulmonary thromboembolism (PE), and the latter is culpable for many deaths annually in the United States.  However, DVT as a complication of uterine leiomyoma has rarely been reported. We report a case of a fair, fatty, female in her fifties whose death was due to a large leiomyomata externally compressing the pelvic veins resulting in stasis and venous thrombosis leading to fatal PE. The association of large pelvic masses with venous thrombosis has clinical implications, since prophylactic surgery could be life-saving. Other findings in this patient were cholelithiasis and cardiomegaly with left ventricular hypertrophy. 
Leiomyoma is the commonest gyneacology tumour which usually regress with age and rarely with   thromboembolic phenomenon. However, the presence of this condition in a patient with high risk index for thrombus formation should necessitate the removal of the tumour in order to prevent sudden death from pulmonary thromboembolism. 


Citation
References
Eggert S.L., Huyck K.L., Somasundaram P., Kavalla R., Stewart E.A., Lu A.T. et al., 2012. "Genome-wide linkage and association analyses implicate FASN in predisposition to Uterine Leiomyomata", Am. J. Hum. Genet., Vol.91(4), pp.621-8, http://dx.doi.org/10.1016/j.ajhg.2012.08.009
 
Segars J.H., Parrott E.C., Nagel J.D., Guo X.C., Gao X., Birnbaum L.S. et al., 2014. "Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: Comprehensive review, conference summary and future recommendations", Human Reproduction Update, Vol.20(3), pp.309-333, http://dx.doi.org/10.1093/humupd/dmt058
 
Tolvanen J., Uimari O., Ryynänen M., Aaltonen L.A., Vahteristo P., 2012. "Strong family history of uterine leiomyomatosis warrants fumarate hydratase mutation screening", Human Reproduction, Vol.27(6), pp.1865-9, http://dx.doi.org/10.1093/humrep/des105
 
Toro J.R. et al., 2003. "Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in North America", Am. J. Hum. Genet., Vol.73(1), pp.95-106, http://dx.doi.org/10.1086/376435
Keywords Pulmonary thromboembolism, leiomyoma, autopsy, calabar
DOI http://dx.doi.org/10.15208/mhsj.2016.03
Pages 16-19
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