30 year old patient with history of spotting &infertility



Doctor's Information

Name : firoozeh.farnaz
Family : ahmadi.akhbari
Affiliation :Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for
Academic Degree : radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------


Case Section

Genital Female Imaging


Patient's Information

Gender : Female
Age : 30


Clinical Summary

A 30 year old patient with history of spotting and infertility


Imaging Findings

Sagittal view of 2-D TVUS demonstrates two small hypoecho masses (fibroma) which are located at the intramural to submocusal at the uterine body. Coronal view of 4-D ultrasound reveals the degree of projection of fibroma in to the endometrial cavity. There are 2 fibromas, one of them was submocusal fibroma with 10% compressor effect and other one was submocusal-intracavity fibroma with more than 50% compressor effect. Fig.1: schematic image of various type of fibroma. Fig2. Sagittal view of uterus (2D TVS) Fig.3: Tomographic uterus imaging (4D TVS) Fig4: Coronal view (4D TVS) Fig5: Sagittal and coronal view of uterus (4D TVS)


Differential Diagnosis

Submocusal fibroma,Polyp


Final Diagnosis

Submocusal fibroma


Discussion (Related Text)

Fibroids, also known as uterine leiomyomas, are non-cancerous tumors coming from the myometrium (the muscle layer) of the uterus. Most are located in the uterine body and fundus, but they can also occur in the cervix. Fibroids are classified as follow :( Fig.1)
-Intramural: confined to the myometrium
-submocusal: projecting into the endometrium
-Subserosal: projecting from the serosal surface of the uterus Fibroids cause symptoms in approximately one out of every four women of reproductive age and usually shrink after menopause. They have various symptoms, including pain and abnormal vaginal bleeding. They could cause ureteral compression, leading to hydronephrosis. Symptom of submocusal fibroma: These fibroids are located just underneath the endometrium and protrude into the uterine cavity. Submucosal fibroids can vary in how much of the fibroid protrudes into the uterine cavity and how much is in the muscle of the uterus. They often cause heavy bleeding and long periods, but they can also cause irregular bleeding. In gray scale ultrasound, transvaginal sonography findings are hypoechoic subendometrial mass and stretched but intact overlying echogenic endometrium in continuity with myometrium. 4-D coronal view of the uterus added value to 2-D images in gynecology case. It can confirm that fibroid is submocusal and assess its degree of projection into the uterine cavity. It is helpful in decision making before surgical treatment of a submocusal fibroid. According to previous studies, there is strong evidence that a coronal image of uterus and endometrium should be considered as a routine pelvic sonography. The thickness of the endometrium plays an important role when evaluating the coronal view of uterus, as the normally echogenic endometrium is used as a visual contrast to the darker myometrium for displaying uterine fibroids and polyps. The thicker the endometrium, the easier it is to outline the shape of the uterine cavity and the present of submocusal fibroid. Previous studies show that 3D coronal view of the uterus are particularly helpful in patients who have an abnormality seen on initial2D imaging of the uterus or in patients with infertility but when the traditional 2D imaging of the uterus is normal, the 3D coronal view is less likely to be contributory.



-Peter M. Doubilet ,Carol B. Benson. Atlas of Ultrasound in Obstetrics and Gynecology: A Multimedia Reference . second edition.2012
-A. Fleischer, E. Toy, W. Lee, F. Manning, R. Romero, Sonography in Obstetrics & Gynecology: Principles and Practice,seventh edition,2011
-H.Heriack,E.Sala,S.Ascher,Diagnostic imaging gynecology,first edition,2007


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