Radiology Teaching Files > Case 5422138

Contributed by: Radiology Residency Program Faculty & Staff, Northeastern Ohio Universities College of Medicine-Canton Affiliated Hospitals, Ohio, USA.
Patient: 42 year old female

42 year old female with left adnexal pain.

7/20/2006: Transvaginal pelvic ultrasound
7/20/2006: Contrast Enhanced CT Abdomen/Pelvis
7/27/2006: MRI Pelvis


Fig. 1: Transvaginal Pelvic Ultrasound

Fig. 2: CE-CT Pelvis

Fig. 3: T2WI MR

Fig. 1: Transvaginal ultrasound
Left coronal and sagittal images: Centrally in the expected location of the endometrial cavity is a 2.5 cm mass.   Differential diagnosis would inclued an intracavitary fibroid or endometrial mass.
Right coronal and sagittal images: Posteriorly there is a 3.7 cm heterogenoeous mixed echogenicity mass, likely a fibroid.  A smaller 1.0 cm intramural mass can also be seen.

Fig. 2: CE-CT Pelvis
Lobular masses within the endometrial cavity are isoattenuating to uterine myometrium.
A small amount of free pelvic fluid is also present.

Fig. 3: T2WI MR
Sagittal T2WI:  Multiple well circumscribed homogeneous hypointense masses are seen within the uterus: Two small lesions intramural in location at the anterior uterine body; a 1.8 cm intracavitary lesion contiguous with the mid uterine body; and a 3.3 cm submucosal lesion at the posterior fundus.  Nabothian cysts are also present.
Axial Oblique and Coronal Oblique T2WI: The intracavitary and submucosal masses are demonstrated.  There is slight inhomegeneity of the larger submucosal lesion, probably secondary to degeneration. A small amount of free pelvic fluid is seen (Axial Oblique T2WI).

Diagnosis: Uterine Leiomyomas - Intracavitary, Submucosal, Intramural

Uterine Leiomyoma

- syn: fibroid
- benign neoplasms derived from the smooth muscle myoma cells of the uterine myometrium
- the most common uterine neoplasm
- present in greater than 20% of women older than age 30 years

Categorized by location:
- subserosal: lesions centered external to the uterus; these can mimic adexal lesions on sonography and physical examination
- intramural: majority of fibroids
- submucosal: leiomyomas with some component extending into the endometrial canal, even if covered by a layer of endometrium
- intracavitary: submucosal fibroids almost entirely located with the endometrial canal

MR findings:
- characteristic low SI on T2-WI
- well circumscribed with well-defined margins
- ~ 1/3 are surrrounded by a high SI rim on T2-WI that correlates with peritumoral lymphatics, veins, and edema

Various types of degeneration:
- most common

- uncommon; associated with leiomyomas during pregnancy
- "red degeneration" with peripheral or central high SI on T1-WI secondary to methemoglobin
- minimal contrast enhancement

- 5% of fibroids
- very high SI on T2-WI
- do not enhance after contrast

- rare: 0.5% of cases
- degeneration into a lipoleiomyoma
- hypothesized as metamorphosis of smooth muscle cells into adipocytes
- can be detected and characterized using fat suppresion techniques

- more accurately detected by radiography and CT

- rare
- difficult to accurately diagnose on MR in the absence of metastatic disease


Brant, WE and Helms, CA. Fundamentals of Diagnostic Radiology. 3rd edition. Lippincott Williams & Wilkins, 2006.

Siegelman, ES., Body MRI. Elsevier, 2005.

Submitted by:

Aakash D. Singh, M.D. – PGY-V Radiology Resident

Mark R. DeGalan, M.D., Ph.D. - Radiologist
Mercy Medical Center

No comments posted.
Additional Details:

Case Number: 5422138Last Updated: 2011-08-15
Anatomy: Genitourinary (GU)   Pathology: Benign Mass, Cyst
Modality: CT, MR, USAccess Level: Readable by all users
Keywords: uterine leiomyoma, fibroidsACR: 851.315

The reader is fully responsible for confirming the accuracy of this content.
Text and images may be copyrighted by the case author or institution.
You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please contact us.