Understanding Uterine Fibroids & Their Sonographic

Appearances

By Natalia Vasquez BS,RDMS,RDCS

Uterine Fibroids

Definition: Benign tumors that develop in the uterus during childbearing years

AKA: Leiomyoma's or mayomas

Incidence: 4 out of 5 women More common in African AmericansUsually detected 30’s & 40’s yrs. of ageShrink after menopause

Symptoms Asymptomatic

Heavy menses bleeding

Longer Menus periods

Pelvic pain

Frequent urination

Rectal pressure / constipation

Bladder pressure / frequent urination

Back pain / leg pain

Infertility

Patient Preparation

1. Patient history- LMP, gravidity, parity, symptoms, previous pregnancy complications, pervious lab results, history of pelvic surgery

2. Written request for examination

3. Transabdominal- Full bladder

4. Transvaginal

5. Patient position- Supine, Semi flower

6. Transducer- 1. Tranabdominal-3.0 MHz-5.0 MHz (5.0MHz for thin patients.

Curved linear array

2. Transvaginal- 5.0-7.0 MHz

Types Of Fibroids

Intramural Fibroids

Subserosal Fibroids

Submucosal Fibroids

Pedunculated Fibroids

Sonogram Intermural Fibroid

Above: transverse & below sagittal view demonstrates a small intermural fibroid located in fundus

Sonographic appearance: • Round focal mass• Located in uterine myometrium

• Most common• Grows within the myometrium • Can distort uterine shape

Subserosal Fibroid

Project outside the uterus

Press on bladder causing urinary symptoms

Press on rectum causing backache

Sonogram Subserosal Fibroid

Project outside the uterus

Press on bladder causing urinary symptoms

Press on rectum causing backache

Sonographic apprence: • L

ocated below the uterine skin

• Can distort the uterine contour

• May become predunctulated

Submusocal Fibroid

Least common

Located under the endometrium

Protrudes into uterine cavity

Cause heavy & long periods

Irregular bleedings

Fertility problems

Distort the endometrial line

Submusocal

Above: sagittal & right: transverse vieww/ hypoechoic submusocal fibroid

Predunculated Fibroid

Attached to the uterus by a stalk

Located inside the uterus or outside

Management Depends on …..

Symptoms

Location

Size

Number

Age

Reproductive plans

Woman’s preferences

TreatmentGonadotropin-releasing hormone: Shrinks Fibroid

Progestins/oral contraceptive pills/androgenic agents/anti-estrogens: Controls heavy bleeding

SurgeryMyomectomy- only fibroid removedHysterectomy- uterus removed Uterine artery/fibroid embolization- blood is blocked

to fibroid MR-Guided focused ultrasound-energy to heat and

destroy causing shrinkage