Presentation
Heavy menstrual bleeding.
Patient Data
The uterus shows two interstitial fibroids in its body, the larger on the right anterior aspect of the body and smaller on the left side. The large fibroid shows a margin of high T1 signal corresponding to subacute hemorrhage and dark T2 rim. No diffusion restriction. The margins also appears hyperintense on the fat sat sequence with no post contrast enhancement.
Findings are suggestive of uterine interstitial fibroid with red degeneration of the large right fibroid.
Case Discussion
Red degeneration of uterine fibroid occurs secondary to obstruction of the draining vein at the periphery of the fibroid. It occurs commonly in pregnant women or women on oral contraceptive pills.
Radiological features include a peripheral rim of distinct low T2 signal and high T1 signal corresponding to subacute hemorrhage. The entire lesion shows no diffusion restriction nor enhancement, which indicates complete interruption of blood flow.