Metrorrhagia. MRI for preoperative evaluation.
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The uterus is diffusely enlarged, showing multiple innumerable leiomyomas (fibroids) of various size and location (submucosal, interstitial and subserous). They demonstrate a low to intermediate signal intensity (as compared with the normal myometrium) on T1, low signal intensity on T2 (non-degenerated leiomyomas) with heterogeneous enhancement following IV contrast. A large pedunculated leiomyoma of submucosal location is noted, prolapsing into the vagina through a distended endocervical canal.
A free intraperitoneal ascites is noted most likely due to a ruptured left ovarian cyst for which she had an ultrasound week ago.
MRI is the most reliable imaging technique for detection of the number, size as well as the location of the uterine leiomyomas, which will be useful to the surgeon in case of myomectomy or the interventional radiologist in case of embolization. it can be used also to evaluate the success or complication after embolization.