Submucosal leiomyoma in the exam
Getting a film with submucosal fibroid in the exam is one of the many exam set-pieces that can be prepared for.
Transabdominal and transvaginal pelvic ultrasound scans show an anteverted uterus with endometrium that is 7mm wide and has a trilaminar appearance indicative of the periovulatory part of her cycle. There are multiple, well defined, nonvascular, heterogeneously hypoechogenic, intramural myometrial masses. These have a typical appearance for fibroids. The largest fibroid in the posterior uterine body is predominantly submucosal and causes endometrial distortion. This could optimally be assessed with 3D ultrasound and sonohysterography and is likely to be the cause of this lady’s subfertility.