Fibroids

When would you suspect fibroid uterus?

What is the imaging procedure of choice?

• Trans vaginal ultrasound with Doppler is the procedure of choice.
• CT and MR can also provide diagnostic information
  • If the mass is very large, it may be difficult to differentiate from ovarian or extra ovarian.  It is then necessary to do CT scan. 
  • If on ultrasound, it is determined that the mass is malignant (or has a high probability for malignancy), before going to the operating room it is necessary to do a CT scan of the patient to look for any metastasis.     

What are the radiological findings of fibroids?

• On ultrasound fibroids are heterogeneous, hypo echoic (which means dark), solid masses. 
• Uterus is enlarged. 
• Fibroid often calcify.

Image atlas of fibroid in US, CT and MR

US: Hypo echoic small fibroid. Small anterior wall myoma.
US: Hypo echoic fibroid
US: Fibroid
US: Longitudinal scan
US: Fibroid with calcifications
US: Endovaginal uterine fibroid.
CT: Arrowheads point to enlarged uterus with multiple fibroids
CT Calcified fibroid. Arrrowheads point to the contour of the uterus.
CT Calcified fibroid. Rectum has contrast from a previous procedure.
CT Calcified fibroid
MR Coronal image. Fibroid. Endometrial cavity has some fluid and is seen as a bright stripe. The fibroids are all hypo intense. Bladder with urine / a bright signal.
MR Sagittal image Calcified fibroid.

Case 1:

 60y/o woman who has just noticed an increasing abdominal fullness and minimal abdominal pain and has a large mass on pelvic exam.

Q: What is your initial imaging procedure?

A: The procedure of choice is trans vaginal ultrasound followed by trans abdominal Ultra sound , because the larger masses from the fundus cannot be seen on trans vaginal ultra sound.   

Case 2:

Patient is a 44 year-old G2P2 who presents with heavy bleeding for the past 2 years. She has to change her menstrual pad every hour.  She has no abdominal pain. On pelvic exam, her uterus is irregular in shape.  She has no adenexal tenderness.  

Q: Which imaging prodcedure would you consider?

Trans abdominal Ultra sound.