PELVIS

Dr Ender Morales
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Uterine leiomyomata is a benign connective tissue tumor found
in or around the uterus, which may be disseminated in rare
cases.

Prevalence: Thirty percent of all women, 40% to 50% of

women older than 50 (one study has demonstrated a rate of
more than 80% in African Americans older than 50),
leiomyomata account for approximately 30% of all
hysterectomies.

Predominant Age: 35 to 50 or older.

Genetics: No genetic pattern.

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Clinical presentation
Often asymptomatic and discovered incidentally. Signs and
symptoms associated with fibroids include:
 vaginal bleeding
 pain
 infertility
 palpable masses
Pathology
Leiomyomas are benign monoclonal tumours predominantly
composed of smooth muscle cells with variable amounts of fibrous
connective tissue. They are commonly multiple (~85% 8), and range
significantly in size.
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Radiographic features
Plain radiograph
 Conventional radiographs have a limited role in the diagnosis of

uterine fibroids, because only heavily calcified fibroids are

depicted on these scans. Extreme enlargement of the uterus
resulting from fibroids may be seen as a nonspecific soft-tissue
mass of the pelvis that possibly displaces loops of bowel.

 Popcorn calcification within the pelvis may suggest the

diagnosis Popcorn calcification refers to amorphous
calcifications often with rings and arcs that resemble popped
corn kernels. This type of calcification may be seen in many
radiological settings including 1:
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 Pelvic ultrasound
Uterine fibroids most often appear on ultra sonograms as
concentric, solid, hypo echoic masses. This appearance results from
the prevailing muscle, which is observed at histologic examination.
These solid masses absorb sound waves and therefore cause a
variable amount of acoustic shadowing
Many of then can be INTRAMURAL or SUB MUCOSAL – SUB
SEROSA

May vary in their degree of echogenicity:

 they can be heterogeneous or hyper echoic, depending on the amount
of fibrous tissue and/or calcification.
 Fibroids may have anechoic components resulting from necrosis.
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Pelvic ultrasound
If fibroids are small and is echoic relative to the uterus, the only
ultrasonographic sign may be a bulge in the uterine contour.
 Fibroids in the lower uterine segment may obstruct the uterine

canal, causing fluid to accumulate in the endometrial canal.

 Calcifications are hyper echoic, with sharp acoustic shadowing.

 Diffuse leiomyomatosis appears as an enlarged uterus with

abnormal echogenicity.
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Transabdominal sagittal sonogram shows a heterogeneous but

predominately hypoechoic posterior uterine fibroid.
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TOMOGRAFIA AXIAL
Limitations of techniques
In the detection of uterine fibroids, CT scanning is limited by the
similar attenuation characteristics of fibroids and healthy
myometrium, although some fibroids may be hypoattenuating.
Fibroid calcifications can be depicted on CT scans.

On CT images, fibroids are usually of soft tissue density but may:

 Exhibit coarse peripheral or central calcification
 They may distort the usually smooth uterine contour
 Enhancement pattern is variable
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CT scan shows a subserosal, 2.3- to 2.5-cm,

right anterior fundal uterine fibroid
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 Pelvic MRI
MRI has an important role:
 In defining the anatomy of the uterus and ovaries
 As well as in assessing disease in patients in whom US findings are confusing
 MRI also may be helpful in planning myomectomy, or selective surgical
removal of a fibroid.

Fibroids appear as sharply marginated areas of low to intermediate

signal intensity on T1- and T2-weighted MRI scans. Coronal T2-weighted
MRI shows an enlarged uterus with multiple fibroids.

One third of fibroids have a hyperintense rim on T2-weighted images as

a result of dilated veins, lymphatic’s, or edema.
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 Pelvic MRI

An inhomogeneous area of high signal intensity may be depicted

on T2-weighted images:
 this results from hemorrhage, hyaline degeneration, edema, or highly
cellular fibroids.

The intravenous administration of gadolinium-based contrast

material usually is not required; however, if it is administered,
fibroids usually enhance later than does the healthy myometrium.
Fibroid enhancement can be hypointense (65%), isointense (23%),
or hyperintense (12%) in relation to that of the myometrium.
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