Diagnostic Ultrasound - Abdomen and Pelvis

Leiomyoma
Diagnoses: Female Pelvis
TERMINOLOGY
• Benign smooth muscle neoplasm of uterus
IMAGING
• Ultrasound (transabdominal and transvaginal) initial study
of choice
○ Circumscribed mass, hypoechoic to myometrium with
posterior acoustic shadowing
○ Variable location: Submucosal, intramural, subserosal,
intracavitary, pedunculated, cervical, or broad ligament
• MR
○ Low T2 signal from smooth muscle proliferation
○ Variable enhancement on post-contrast imaging
○ High signal on T1WI if hemorrhage; high signal on T2WI if
cystic degeneration
TOP DIFFERENTIAL DIAGNOSES
• Adenomyosis
• Focal myometrial contraction
KEY FACTS
• Leiomyosarcoma
• Uterine duplication
CLINICAL ISSUES
• Symptoms primarily related to leiomyoma location, size,
&/or growth
• Can undergo rapid growth during pregnancy
• For bulk symptoms or bleeding, management includes
uterine artery embolization, myomectomy, or
hysterectomy
• If greater than 50% of submucosal leiomyoma is within
endometrial cavity, will require hysteroscopy for removal
DIAGNOSTIC CHECKLIST
• If borders are not well delineated, consider adenomyosis
• SIS to evaluate submucosal leiomyomas
• MR prior to uterine artery embolization, and to evaluate
multiple or complex leiomyomas
• Consider malignant form if rapidly growing uterine mass in
postmenopausal woman
(Left) Coronal graphic shows
various leiomyoma locations
including submucosal and
endocavitary ſt, subserosal
st and pedunculated , and
mural and cervical .
Note the whorled consistency.
(Right) Transvaginal
ultrasound demonstrates a
hypoechoic, slightly
heterogeneous mass ſt
without significant distortion
of the endometrium ,
consistent with an intramural
leiomyoma. Note the posterior
acoustic shadowing st.
(Left) Transvaginal ultrasound
demonstrates a hypoechoic
subserosal pedunculated
leiomyoma with posterior
acoustic shadowing . An
isoechoic submucosal
leiomyoma ſt causes
distortion of the endometrium.
(Right) Saline-infused
sonohysterography (SIS)
clearly demonstrates the
intracavitary location of a
hypoechoic submucosal
leiomyoma ſt. Posterior
shadowing st is the result of
fibrous tissue, not
calcifications.
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