Presentation
Nulliparous lady with uterine fibroids and menorrhagia.
Patient Data
Moderately bulky (~236 cc), anteverted and non-gravid uterus that maintain its pear shape however, with evidence of multiple variable sized heterogeneous and hypoechoic solid uterine fibroids measuring, viz:
1.95 x 1.73 cm (intracavitary within the proximal inferior third of the endometrial cavity and demonstrates a vascular stalk communicating with the uterine myometrium)
4.08 x 3.39 cm (intramural; located fundally towards the right uterine wall aspect)
4.41 x 2.97 cm (intramural; located fundal-posteriorly towards the right lower 1/2 uterine wall aspect)
1.01 x 1.25 cm (intramural; located postero-medially towards the inferior 1/3 aspect) noted.
The double laminar endometrial stripe thickness of 1.80 cm (in the AP diameter) noted is most likely due to the late proliferative phase. The cervix grossly looks normal. Both ovaries are normal. A leading follicle is noted within the left ovary measuring 1.70 x 1.45 cm. The adnexae and the cul-de-sac are clear.
Case Discussion
Vividly conspicuously hypoechoic, circumferential small sized solid structure (fibroid) centered within the proximal endometrial cavity and attached with a vascular stalk to the myometrium visualized on a trans-abdominal pelvic ultrasound.
Spectral Doppler analysis of the vascular stalk shows low profile resistance arterial flow and there are multiple intramural myomas (similar in morphology) accompanying the intracavitary fibroid as indicated.
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