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-(a) Axial contrast enhanced CT image through the pelvis from 2011 reveals the minimally heterogeneous pedunculated fibroid (arrows) extending from the right lateral uterus. (b) Sagittal contrast enhanced CT image through the pelvis in 2011, with partially imaged minimally homogeneous exophytic uterine fibroid (arrow).
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Torsion of a pedunculated uterine leiomyoma is an incredibly rare occurrence, considered a surgical emergency due to the risk of ischemic gangrene and resulting reactive peritonitis. Imaging modalities have traditionally played a limited role in evaluation of leiomyoma torsion due to modest sensitivity and specificity. We present the case of a 58-y...
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Context 1
... nulliparous, postmenopausal 58-year-old female with past medical history of hypertension presented to our emergency department with a chief complaint of excruciating lower abdominal pain acutely worsening over the past day with associated nausea, emesis, and diarrhea. She had a remote CT from 2011 which revealed an exophytic fibroid extending from the right uterus measuring up to 7 cm ( Fig. 1 ). She had been seen the day prior at a separate facility, where a computed tomography (CT) of the abdomen/pelvis demonstrated enlargement of the known pedunculated fibroid since 2011, now measuring up to 9 cm ( Fig. 2 ). ...
Similar publications
Torsion of a uterine leiomyoma is an extremely rare, albeit life-threatening surgical emergency. A 28-year-old woman presented with acute abdominal pain. Imaging revealed a torsed subserosal uterine leiomyoma which was managed surgically and the diagnosis confirmed intraoperatively as well as on histopathology.
Contribution: While intraoperative f...
Citations
... Although the diagnosis of torsion of a pedunculated subserosal uterine fibroid is typically confirmed intraoperatively in most cases, modern imaging modalities can provide valuable preoperative information [9]. Doppler ultrasonography can raise suspicion of leiomyoma torsion by detecting reduced blood supply when the vascular pedicle is visible [10]. ...
Torsion of pedunculated subserosal leiomyoma of the uterus is a rare cause of acute abdomen. A 27-year-old female patient with twisted subserosal pedunculated uterine leiomyoma misdiagnosed as an adnexal mass underwent laparotomy. The patient came to the Emergency Department of General Hospital of Trikala with symptoms of acute abdomen. Primarily, clinical-laboratory examination, transabdominal ultrasound, raised the suspicion of a twisted adnexal mass. Intraoperatively, a twisted pedunculated subserosal leiomyoma of the uterus was identified and myomectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis. On the third postoperative day, our patient was discharged. This paper underscores the rarity of torsion of the uterine pedunculated subserosal leiomyoma and emphasizes the necessity of urgent surgical intervention. The challenges of preoperative diagnosis are highlighted, especially when modern diagnostic imaging modalities are unavailable.
... However, torsion of a pedunculated uterine leiomyoma is extremely rare, with a reported incidence of less than 0.25% [3]. Torsion of a pedunculated leiomyoma is considered an emergency due to the risk of ischemic gangrene and reactive peritonitis [4]. Since it is difficult to diagnose a twisted pedunculated leiomyoma solely on the basis of clinical findings, the judicious use of radiological imaging becomes a fundamental tool for achieving a precise diagnosis [5]. ...
Uterine leiomyomas are benign uterine tumors arising from the smooth muscle cells of the myometrium. Most of them are asymptomatic, and rarely do they present with symptoms like infertility, abdominal distension, and acute abdomen. According to experts, the most common cause of acute abdomen is torsion of a pedunculated subserosal leiomyoma, which is an extremely rare and life-threatening surgical emergency. Here, we discuss a case of torsion of a subserosal leiomyoma where the patient, a 40-year-old female with severe abdominal pain, was misdiagnosed with a twisted ovarian cyst. Ultrasonography and contrast-enhanced computed tomography (CECT) revealed a right-sided ovarian tumor and a twisted subserosal myoma, respectively. Thus, surgical intervention with myomectomy was done.
... It is often diagnosed intraoperatively as its imaging findings are non-specific and overlap with the more commonly encountered leiomyoma degeneration, thus making its pre-operative diagnosis rather difficult. 3 This case report describes the imaging findings in a case of a torsed, pedunculated, subserosal uterine leiomyoma. ...
... Uterine fibroids or leiomyomas are benign, smooth-muscle neoplasms and are the most common gynaecologic tumours, found in 60% of women in their reproductive ages. 3 Uncomplicated fibroids are often asymptomatic; however, when symptomatic they may result in abdominal pain, menorrhagia, dysmenorrhoea and infertility. Severe complications include torsion, degeneration, intraperitoneal haemorrhage, prolapse of submucosal fibroids, acute urinary retention and venous thrombosis. 2 Torsion of a uterine leiomyoma is a rare cause of acute abdomen with an incidence of less than 0.25% reported in a single-centre retrospective study of complicated subserosal fibroids requiring surgery. ...
... This often leads to this uncommon condition being only diagnosed at the time of surgery. 3 The clinical presentation is variable depending on the degree and speed at which the torsion develops. If the torsion is partial and intermittent with spontaneous untwisting, symptoms may be intermittent, constant or even resolve spontaneously. ...
Torsion of a uterine leiomyoma is an extremely rare, albeit life-threatening surgical emergency. A 28-year-old woman presented with acute abdominal pain. Imaging revealed a torsed subserosal uterine leiomyoma which was managed surgically and the diagnosis confirmed intraoperatively as well as on histopathology.
Contribution: While intraoperative findings remain the primary means of diagnosis, radiologists should be familiar with the potential imaging findings of leiomyoma torsion as timely intervention can greatly improve patient outcome.
... These fibroids have a non-myometrial (for example, cervical, broad ligament, parasitic) location. Diagnosis of broad ligament fibroids using imaging procedures is challenging, because they may be mistaken for ovarian tumours and manifest as urine outflow obstruction or secondary hydroureteronephrosis in variable degrees due to compression of the urethra, bladder neck, or ureter (19). In our case, a 54-year-old patient presented with dysmenorrhea and lower abdominal pain. ...
Uterine fibroids are the most common gynaecologic malignancy, but only 20% of women need treatment to relieve their symptoms. The management of fibroids has changed from open to laparoscopic hysterectomy, myomectomy and minimal invasive techniques such as uterine artery embolization and ablation. Magnetic resonance imaging (MRI) is considered the best modality in the diagnosis, characterization and number of fibroids as well as for accessing extrauterine relationships, associated diseases; it also helps in planning, choosing and prognosis of treatment options. Traditionally, uterine fibroids were classified according to their location as submucosal, intramural or subserosal. However, for minimally invasive techniques, the relation of the fibroid with the endometrium, the degree of fibroid extension in the myometrium and the pedunculated nature of the fibroid are required before the procedure. The FIGO classification system was created to describe and classify fibroid locations in a systematic and consistent manner with suitable communication to the referring doctor. We are providing an array of clinical symptoms, MRI images, and surgical approaches on the basis of FIGO classification and associated important points to diagnosis and clinical implications.
... Sin embargo, la influencia real de los miomas en los resultados obstétricos no está del todo clara; la cantidad, el tamaño, la ubicación y la relación de los miomas con la placenta varían, y por lo tanto sus efectos potenciales también pueden divergir 3,5 . Los miomas sintomáticos, según su tamaño y ubicación en el útero, pueden manifestarse con síntomas como presión pélvica, dolor abdominal, sangrado uterino anormal, dismenorrea, síntomas de la vejiga como frecuencia urinaria o intestinales como estreñimiento 2 , e incluso se ha informado obstrucción del tracto gastrointestinal debido a un mioma uterino, pero generalmente es secundaria a una compresión externa por un mioma de gran tamaño o también secundaria a un vólvulo de intestino delgado [7][8][9] . El dolor puede resultar de la degeneración o torsión de un mioma pediculado; en particular, la degeneración roja, que ocurre principalmente durante el embarazo 3,8 . ...
... Hasta la fecha hay reportes de casos de torsión de miomas uterinos pediculados, con una incidencia de menos del 0,25%, pero pocos reportes sobre complicaciones intestinales, siendo estas una urgencia quirúrgica debido al alto riesgo de gangrena isquémica y la consiguiente peritonitis reactiva 9 . Durante el embarazo hay pocos casos reportados de complicaciones intestinales secundarias a miomas uterinos, en especial durante el tercer trimestre. ...
Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.
... A study examining the incidence of degeneration of leiomyoma in patients referred for uterine fibroid embolisation underwent MRI found an incidence of 5.1% [29]. Torsion and rupture are a rare entity (reported incidence for torsion of less than 0.25%) [30]. ...
Pelvic pain in reproductive age often represents a diagnostic challenge due to the variety of potential causes characterized by overlapping clinical symptoms, including gynecological and other disorders (e.g., entero-colic or urological). It is also necessary to determine if there is a possibility of pregnancy to rule out any related complications, such as ectopic pregnancy. Although ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are strongly integrated, the choice of which is the ideal diagnostic tool should be guided both by clinical suspicion (gynecological vs. non-gynecological cause) and by the risk ratio–benefit (ionizing radiation and instrumental costs), too. The didactic objective proposed by this review consists in the diagnosis of the cause and differential of pelvic pain in reproductive age by describing and critically analyzing the US diagnostic clues of the most frequent adnexal, uterine, and vascular causes.
... Uterine leiomyomas, are clonal tumors originating from uterine smooth muscle cells, which usually occurs in women of childbearing age, ranging 30-50 years old [1]. The incidence of uterine leiomyomas is about 20-30%. ...
Under solvothermal conditions, two new Zn(II)-based coordination polymers, namely {[Zn(tptc)0.5(2,2′-bpy)]·dioxane}n (1, H4tptc = p-terphenyl-2,2″,5″,5‴-tetracarboxylate acid, 2,2′-bpy = 2,2′-bipyridine) and [Zn(tptc)0.5(bib)]n (2, bib = 1,3-bis((imidazol-1-yl) benzene), have been synthesized using the mixed-ligand approach. Furthermore, the luminescence studies show that complex 2 can test acetylacetone selectively and sensitively, and the detection limit is 1.72 ppm. In addition, we evaluated the compounds therapeutic effect against uterine leiomyomas. The uterine leiomyomas rats model was established, the compound 1 and compound 2 was used for treatment. The detection of the transforming growth factor-β (TGF-β) releasing from endometrial stromal cells into plasma was detected with an enzyme linked immunosorbent assay (ELISA) detection kit. Then, the mmp-3 and mmp-7 relative expression levels in the uterine smooth muscle cells after compound treatment were measured by the reverse transcription-polymerase chain reaction (RT-PCR).
... The presence of abdominal pain and a heterogeneous fibroid on imaging corresponding to the site of pain on physical examination is more likely to be a degenerating fibroid, as fibroid torsion is a less common entity, unless the fibroid is pedunculated [27,96]. Patients most often have imaging to exclude more common etiologies of abdominal pain such as acute appendicitis, diverticulitis, or pelvic inflammatory disease [96,97]. Torsion of a pedunculated fibroid remains a diagnosis of exclusion, most often confirmed at surgery, since the ultrasound and CT findings are often inconsistent or subtle, and require a high level of clinical suspicion [97]. ...
... Patients most often have imaging to exclude more common etiologies of abdominal pain such as acute appendicitis, diverticulitis, or pelvic inflammatory disease [96,97]. Torsion of a pedunculated fibroid remains a diagnosis of exclusion, most often confirmed at surgery, since the ultrasound and CT findings are often inconsistent or subtle, and require a high level of clinical suspicion [97]. Research into features of subserosal fibroid torsion on contrast-enhanced CT has demonstrated relatively high positive predictive value and accuracy in diagnosing torsion when the fibroid demonstrates poor internal enhancement, and when the uterine parenchyma adjacent to the torsed fibroid has fan-shaped hypoenhancement [98], MRI may be used to follow or characterize fibroids; however, it is uncommonly utilized in the acute setting for assessment of fibroid torsion. ...
... On US, if technically feasible, absent color or spectral Doppler flow within the vascular pedicle and the fibroid itself are of substantial diagnostic value [97,98]. Twisting of the vascular pedicle of the fibroid along with other ancillary imaging findings can yield a more confident diagnosis [97]. ...
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
... As was the case with Ms FM, the initial CT abdomen and pelvic ultrasound scans were unremarkable but subsequent imaging revealed significant bowel distention and gut perforation. Torsion of a uterine leiomyoma could be identified by both CT and pelvic ultrasound (USS) imaging modalities although USS is less sensitive as a screening tool, possibly because its accuracy depends on the the technical knowhow of the individual performing the investigation [9] [10]. ...
... [1] Torsion of a pedunculated fibroid resulting in an acute abdomen requires immediate surgical intervention, as prolonged torsion can result in ischemic gangrene and resulting peritonitis. [4] Although uterine leiomyomas are exceedingly common, pedunculated uterine leiomyomas are uncommon and torsion of a pedunculated leiomyoma is very rare. Knowledge of unusual presentation of the benign fibroids is essential to the clinicians, which help in differentiating benign from malignant tumor entities. ...
Fibroids are rare in postmenopausal females. Torsion of pedunculated uterine fibroid is also a very rare occurrence in elderly females. We report a rare case of an 84-year-old multiparous, postmenopausal female, a treated case of non-Hodgkin's lymphoma, presenting with a large abdominal mass. The comparative positron emission tomography/computed tomography scan study of the patient revealed that a new mass in the abdomen and pelvis connected with the left adnexa with a pedicle and previously seen fibroid was not visualized on the present scan, thus raising suspicion of torsion of subserosal fibroid. Histopathology confirmed the diagnosis of fibroid.
