Presentation
Abnormal vaginal bleeding with palpable pelvic masses.
Patient Data
The uterus is diffusely enlarged with multiple leiomyomas of various sizes mainly of intramural location (Figo 3, 4, 5), the largest is prolapsed in the Douglas pouch and measures 10 x 9 x 8 cm. They elicit an isosignal to the myometrium on T1, low signal on T2 with central areas of high signal within the left largest leiomyomas (cystic degeneration). The post-contrast sequences demonstrate moderate and heterogeneous enhancement. Note mild bleeding within the uterine cavity of low signal on T2.
Both ovaries appear normal with small follicles, the largest on the right (22 mm).
Case Discussion
MRI features of multiple uterine leiomyomas.