MASSIVE FIBROID ( LEIOMYOMA )


This was a 48 year old lady who was seeing me on and off for diabetes mellitus and systemic hypertension . She came to me a few months ago for uncontrolled diabetes. Her Blood sugar was around 400 mgms/dl and she was started on insulin for better control. The patient  had history of  irregular periods with history of menorrhagia for the last 3 cycles .She again came 2 weeks later for complaints of fever on and off. Her blood sugar had come under control . On clinical examination a mass was felt in the right hypochondrium and she went through an abdominal scan.

Two distinct mass lesions were seen in the right side of the abdomen in the lumbar and  hypochondriac regions . Though they appeared distinct from the liver , it was a bit confusing.

MASSIVE FIBROID _5 MASSIVE FIBROID _6 MASSIVE FIBROID _7 MASSIVE FIBROID _8 MASSIVE FIBROID _9

The mass lesions are seen below.

MASSIVE FIBROID _1 MASSIVE FIBROID _3

 

 

MASSIVE FIBROID _4

Uterus was massively enlarged and showed a large fibroid . Uterine texture also showed features of adenomyosis and endometrial thickening.

MASSIVE FIBROID _10 MASSIVE FIBROID _11 MASSIVE FIBROID _12 MASSIVE FIBROID _13

 

Thw two masses seen out of the uterus and mainly in the right upper quadrant  are shown below.

MASSIVE FIBROID _18 MASSIVE FIBROID _19

The ultrasound gave us a few inconclusive findings . Uterus was massively enlarged ; a large fibroid was seen ; adenomyosis was seen ; endometrium was thickened ; two large mass lesions were seen in the right upper quadrant and right lumbar region . But it was difficult to ascertain the origin of these extra uterine masses .

So a CT scan was done next . These pictures are reproduced here using a cell phone’s camera.

The following picture shows the enlarged uterus and large sub serous myomas extending upto the liver.

IMG_2139

The next picture shows the adenomyosis

IMG_2145

 

 

IMG_2151 IMG_2150

 

The large sub serous fibroids are seen below.

 

IMG_2147

The liver is shown below.

IMG_2146

 

IMG_2153

IMG_2152

 

IMG_2151 IMG_2150

 

Even after the CT scan pictures , at least two surgical teams were reluctant to operate.

At last she was operated in a medical college hospital . Per operative and biopsy findings were nearly the same .

Enlarged uterus with leiomyoma with mucinous and cystic degeneration and adenomyosis and two large sub serous fibroids arising from the fundal and right lateral aspect undergoing hyalinisation. 

There was no evidence of any carcinoma or lymphoma. 

The patient is doing well post operatively.

This case is presented here to stress how ultrasound can be found wanting in certain circumstances and CT scan scores over ultrasound in such conditions.

 

 

8 thoughts on “MASSIVE FIBROID ( LEIOMYOMA )

  1. Even so, I believe that the ultrasound still is the fastest and easiest ways to conduct viewing in the patient. Because of the findings on the ultrasound, the large uterus mass and other massess were identified. Concluding abnormality of uncommon proportion, thus requiring further imaging via CT-scan or MRI. I don’t like thinking in terms of superiority. No imaging procedure is superior to the other, yet, they have there own merits and can complement findings to the other methods. I strongly believe in the quick and affordable diagnostics with ultrasound, especially in primary care setting, where I work as a GP. Buy the way, good case and photos.

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  2. I agree with prior posts on this topic. Ultrasound can be quickly performed and has lower costs than many other modalities. Though all modalities have varying benefits that help diagnose patients.

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