Submucosal leiomyomas of the uterus refer to a subtype of uterine leiomyoma that primarily projects into the endometrial cavity. They are least common albeit the most symptomatic type of leiomyoma.
Submucosal leiomyomas can be a common source of abnormal uterine bleeding and may also present with reproductive dysfunction, including recurrent miscarriages, infertility, premature labour and/or fetal malpresentation.
They are also a recognised cause of infertility.
It is typically seen as a subendometrial mass indenting and distorting the endometrium. Please, refer to the main article on uterine leiomyomas for a detailed discussion on leiomyomas imaging features.
On ultrasound, submucosal fibroids are typically seen as broad-based, hypoechoic, well-defined, solid masses with shadowing. Submucosal fibroids typically have an overlying layer of the echogenic endometrium, which helps confirm their subendometrial location and helps distinguish them from endometrial polyps. In addition, as opposed to polyps, submucosal fibroids often distort the interface between the endometrium and myometrium and show acoustic attenuation.
T2: typical homogenous hypointensity is seen
- atypical findings may include hyperintensity due to oedema
General imaging differential considerations include:
- 1. Straub HL, Chohan L, Kilpatrick CC. Cervical and prolapsed submucosal leiomyomas complicating pregnancy. Obstet Gynecol Surv. 2010;65 (9): 583-90. doi:10.1097/OGX.0b013e3181fc5602 - Pubmed citation
- 2. Murase E, Siegelman ES, Outwater EK et-al. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics. 19 (5): 1179-97. Radiographics (full text) - Pubmed citation
- 3. Garcia CR, Tureck RW. Submucosal leiomyomas and infertility. Fertil. Steril. 1984;42 (1): 16-9. - Pubmed citation
- 4. Panageas E, Kier R, Mccauley TR et-al. Submucosal uterine leiomyomas: diagnosis of prolapse into the cervix and vagina based on MR imaging. AJR Am J Roentgenol. 1992;159 (3): 555-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 5. Davis PC, O'neill MJ, Yoder IC et-al. Sonohysterographic findings of endometrial and subendometrial conditions. Radiographics. 22 (4): 803-16. Radiographics (full text) - Pubmed citation