Uterine leiomyoma prolapsing into vagina - ovarian hemorrhagic cyst
Presentation
Pelvic pain
Patient Data
A large solid heterogeneous hypoechoic mass enlarging the vagina
A multiseptated left ovarian cystic mass
Subseptate uterus with numerous small intramural leiomyomas. A large pedunculated leiomyoma (7 x 6 x 5.5 cm) arising from the posterior wall of the lower uterine segment, and prolapsing into the vagina through a distended endocervical canal. It displays an intermediate signal (as compared with the normal myometrium) on T1, inhomogeneous low signal on T2 with no significant enhancement on postcontrast sequences.
A left ovarian cyst (6 x 5.4 x 4.2 cm) of high signal rim on T1 with low signal centrally (chronic stage at the center and subacute peripherally), high signal on T2 with low signal sediment indicating blood products. The postcontrast sequences show regular peripheral enhancement.
Minimal intraperitoneal fluid in Douglas pouch.
Case Discussion
MRI features of a large uterine leiomyoma prolapsing into the vagina with a hemorrhagic ovarian cyst.
MRI is the most reliable imaging technique for detection of the number, size as well as the location of the uterine leiomyomas, and rule out in such case a prolapsed endometrial polyp or neoplasm of the cervix extending to the upper vagina.
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