45-year-old woman presented with vague pelvic pain

 

Images

Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

 

Case Section

Genital Female Imaging

 

Patient's Information

Gender : Female
Age : 45

 

Clinical Summary

45-year-old woman presented with vague pelvic pain

 

Imaging Findings

MR images show a midline well-circumscribed thick-walled cystic mass with internal septum and central signal intensity consistent with fluid.The images reveal continuity of the cyst wall with uterine myometrium,indicating a uterine leiomyoma with cystic degeneration.There are also another intramural and subserosal liomyomas within the uterine wall.

 

Differential Diagnosis

1.Cystic ovarian lesion (e.g, follicular cyst,corpus luteum cyst,cystadenoma,cystadenocarcinoma,tubo-ovarian abscess) ,2.Non-ovarian cyst(e.g, endometrioma,paraovarian cyst,hydrosalphinx,ectopic pregnancy,leiomyoma with cystic degeneration,lymphangioma,lymphocele) ,3.Mimics of cystic lesion(e.g, ascites,pelvic varices,illiac aneurysm,diverticulitis,hematoma)

 

Final Diagnosis

Leiomyma with extensive cystic degeneration

 

Discussion (Related Text)

MRI plays a crucial role in determining the origin and nature of a pelvic mass in cases with inconclusive USG features.MRI appearances of leiomyomas vary widely and may present a diagnostic problem.On T2W images, leiomyomas are usually well-circumscribed masses which are sharply demarcated from the surrounding myometrium. Distinct low signal on T2W images is a typical MRI finding and is due to extensive hyalinization. Degenerated leiomyomas show variable MR appearances. Red degeneration is characterized by the presence of a peripheral rim which shows low signal on T2W images and high signal on T1W images, corresponding to the obstructed veins at the periphery of the mass.Cystic leiomyomas typically show decreased T1W and increased T2W signal intensities, with no enhancement of the cystic areas. MRI is a useful imaging tool to demonstrate the pedicle or the presence of a normal uninvolved ovary - findings which are likely to enable a more accurate preoperative diagnosis.

 

References

Indian J Radiol Imaging. Feb 2008; 18(1): 69–72

 

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