35y woman with abdominal mass

 

Images

Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Ensi Khalili Pouya

 

Case Section

Abdominal Imaging

 

Patient's Information

Gender : Female
Age : 35

 

Clinical Summary

35y woman with abdominal mass and pain

 

Imaging Findings

CT scan with IV contrast in axial view demonstrates huge, pelvic mass with extension to abdominal cavity with cystic components and enhancement less than myometrium. It originates from left side of uterus; also left ovary is not seen so these findings are more in favor of solid cystic mass which is originated from left ovary. But uterus masses are in DDx.

 

Differential Diagnosis

1-ovarian mass 2-uterus mass

 

Final Diagnosis

Uterus leiomyomatosis with cystic degeneration

 

Discussion (Related Text)

Uterine fibroids are classified according to their location within the uterus as submucosal, intramural (interstitial), and subserosal types.Although most leiomyomas are clinically silent, their location determines potential symptoms. Submucosal leiomyomas, which are least common, are the most likely to cause symptoms such as abnormal uterine bleeding and infertility Disorders. Intramural fibroids, the most common type, may cause menorrhagia, infertility, or pelvic pain.Parasitic leiomyoma is a pedunculated subserosa I fibroid that develops a new blood supply from adjacent structures, usually the omentum, and becomes completely detached from the uterus.49 Acute pain is usually a manifestation of acute degeneration, hemorrhage, torsion, prolapse of a subserosal leiomyoma, or, rarely, rupture or infection. Leiomyomas are best diagnosed with T2-weighted images, and lesions as small as 5 mm can be routinely depicted by MRI.The typical MR appearance is solitary or, more commonly, multiple round, well-circumscribed lesions, often with homogeneously decreased signal intensity relative to myometrium on T2-weighted images .Leiomyoma with hyaline degeneration or calcification exhibits low signal intensity on T2-weighted images. Calcifications, which are found in 10% of cases on CT, appear as mottled, whorled or streaked, or ringlike. In cystic and myxoid degeneration, central high signal intensity on T2weighted images is found. A rim of high signal intensity due to edema or dilated lymphatics or veins may surround intramural or subserosal myomas. On Tl-weighted images leiomyomas appear isointense to myometrium; large myomas may display mass effect, and feeding serpiginous vessel may be noted in their periphery. In pedunculated fibroids, passing vessels may be identified within the stalk.The appearance after intravenous contrast administration is variable. Most myomas enhance similar to or less than the surrounding myometrium on both contrast-enhanced MRI and CT. dynamic MRI the majority of subserosalleiomyomas show arterial vesssels.

 

References

Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009.

 

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