A histopathologically proven case of disseminated peritoneal leiomyomatosis in an adult patient with a confirmed history of hysterectomy approximately 15 years ago. The hysterectomy was an open surgical procedure rather than a laparoscopic one and the likely use of a power morcellator is not clinically suspected. Based on the sonographic and CT appearance, offered differentials included lymphoma, metastatic lymphadenopathy of an occult/ unknown primary malignancy and diffuse peritoneal carcinomatosis.

Surgery was planned as a 2 step procedure, to initially excise some lesions and obtain excision histology and return for a more definitive combined surgical and gynecological procedure at a delayed stage based on histological results.

The CT was performed as a staging study from the thorax to the symphysis pubis and image acquisition is significantly degraded due to the elevated BMI and body habitus of the patient as appreciated by the CT scout views and grainy venous phase.

The lobulated left lower lobe mass lesion is non-enhancing and the differentials include a hamartoma. Benign metastasizing leiomyoma is a rare possibility in this instance and can only be proven on histology.