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 fetal malpresentation. Submucosal leiomyomas can grow rapidly in pregnancy.
More common in premenopausal women, 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. Also, as opposed to polyps, submucosal fibroids often distort the interface between the endometrium and myometrium and show acoustic attenuation.
When internal vessels are seen, a submucosal fibroid will typically have multiple feeding vessels, as opposed to the single vascular pedicle for an endometrial polyp 6.
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
- 6. Gupta A, Desai A, Bhatt S. Imaging of the Endometrium: Physiologic Changes and Diseases: Women's Imaging. (2017) Radiographics : a review publication of the Radiological Society of North America, Inc. 37 (7): 2206-2207
Ultrasound - gynaecology
- ultrasound (introduction)
- acute pelvic pain
- chronic pelvic pain
- Mullerian duct anomalies
- ovarian follicle
- ovarian torsion
- pelvic inflammatory disease
- ovarian cysts and masses
- ovarian cyst
- corpus luteum
- haemorrhagic ovarian cyst
- ruptured ovarian cyst
- ovarian epithelial tumours
- granulosa cell tumours of the ovary
- paraovarian cyst
- polycystic ovaries
- ovarian hyperstimulation syndrome
- post-hysterectomy ovary
- fallopian tube