Leiomyomas (fibroids) are the most common neoplasms of the uterus. A leiomyoma is a benign, smooth muscle tumor of the uterus that may also be referred to as a fibroid or uterine myoma. Leiomyomas are the leading cause of hysterectomy and gynecologic surgery. These tumors can vary in size and may alter the shape of the uterus and have varying sonographic appearances.
Risk factors for the development of fibroids are:
Obesity , black women , non-smokers, and perimenopausal women.
Clinical findings include pelvic pressure, menorrhagia, palpable abdominal mass, enlarged uterus, urinary frequency, dysuria, constipation, and possibly infertility.
Sonographic findings:
Sonographically, leiomyomas have variable appearances. Leiomyomas are most often hypoechoic or heterogeneous in echotexture. They frequently distort the external contour of the uterus. Many leiomyomas demonstrate areas of acoustic attenuation or shadowing. The attenuation is thought to be caused by dense fibrosis within the tumor.
Shadowing is a very useful diagnostic feature in distinguishing a pedunculated leiomyoma from other types of adnexal masses. Calcification may occur in fibroids of older females, frequently appearing as focal areas of increased echogenicity with shadowing or as a curvilinear echogenic rim. When fibroids undergo rapid growth, they tend to outgrow their blood supply, leading to degeneration and necrosis and producing areas of decreased echogenicity or cystic spaces within the fibroid. This tends to occur more often during pregnancy, affecting about 7% to 8% of pregnant patients with fibroids, who may present with pain over this area.
Although uncommon, pedunculated fibroids may undergo torsion.
Submucosal fibroids may compress on the endometrium, distort the cavity. Transvaginal sonography allows better differentiation between a submucosal and an intramural lesion and its relationship to the endometrial cavity.
Sonohysterography and more recently 3-D ultrasound is very helpful to determine the exact location and relationship of the fibroid to the endometrium. Fibroids with at least 50% of the mass projecting into the endometrial cavity can be resected hysteroscopically.
In many cases, SHG and 3-D sonography may also be necessary to distinguish a submucosal leiomyoma from an endometrial lesion. Submucosal fibroids are usually broad-based solid hypoechoic masses with an overlying layer of echogenic endometrium.
Color Doppler ultrasound is valuable in showing uterine vessels supplying the fibroid.
Large fibroids are usually better assessed transabdominally, and subserosal or pedunculated fibroids may be missed if the transvaginal approach alone is used, because of the limited field of view.
We offer Various type of Ultrasound Diploma, certificate and training Courses for Qualified MBBS Doctors in World. We offer online and Offline Courses. Our Courses are following in our online ultrasound institute.
1. Abdominal Ultrasonography Course
2. Infertility Ultrasound Course
3. Obstetrics & Gynaecology Ultrasound Training Course
4. Fetal Ultrasound Training Course
5. Gynaecology Ultrasound Courses
6. Vascular Ultrasound Courses
7. Musculoskeletal Ultrasound Course
8. Transcranial Doppler Ultrasound
9. Obstetric Ultrasound Courses