Fibroids

When would you suspect fibroid uterus?
What is the imaging procedure of choice?
What are the radiological findings of fibroids?

Image Atlas of Fibroid in US, CT and MR

US: Hypoechoic small fibroid

Small anterior wall myoma

US: Hypoechoic 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 hypointense.

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.

Question: What is your initial imaging procedure?

Answer: The procedure of choice is transvaginal ultrasound followed by transabdominal ultrasound, because the larger masses from the fundus cannot be seen on transvaginal ultrasound.   

 
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.  

Question: Which imaging prodcedure would you consider?

Answer: Transabdominal ultrasound.