Presentation
Pelvic mass with dysmenorrhea and menorrhagia. For infertility workup.
Patient Data
There is a bulky and enlarged uterus with multiple ill-defined leiomyomas. These appear predominantly intramural and subserosal. There is a solitary fundal pedunculated leiomyoma. There is evidence of hyaline degeneration. The ovaries are not identified on trans pelvic ultrasound.
Sonographer: Ms S. Mashiane
Cine loops demonstrate diffuse uterine leiomyomatosis more convincingly. The heterogeneous uterine appearance is dramatic.
Case Discussion
Leiomyomas are often encountered during infertility workups. This case represents the sonographic appearance of suspected diffuse uterine leiomyomatosis with near-total replacement of the normal uterine myometrium by multiple, ill-defined, scattered and confluent leiomyomas. Identification of circumscribed calcification suggests developing hyaline degeneration. Static ultrasound images do not convey the extent of the diffuse nature of the leiomyomas. The cine loops assist significantly in appreciating the heterogeneous uterine architecture due to the diffuse replacement of the myometrium by the leiomyomas.