We report the usefulness of a technique called direct-MDCT venography in the diagnostic workup of a patient with an inferior vena cava leiomyosarcoma. The technique consists in the injection of contrast agent through both lower limbs achieving maximum enhancement in the inferior vena cava. Images are similar to those of the gold standard conventional cavography. To our knowledge, this is the first description of the direct-MDCT imaging appearance of an inferior vena cava leiomyosarcoma.