Fact-sheet: Necrotic leiomyoma
Updated on 10/06/2017 at 4:39 PM
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Definition
This is a leiomyoma infarction.
Aseptic necrobiosis of the fibroid may manifest several years later with its involution and a significant reduction in volume.
Leiomyoma with hemorrhagic degeneration = necrobiosis = 10% of leiomyomas.
See the "Leiomyoma" course sheet to complete your knowledge.
Clinical features
Acute pelvic pain.
Context of pregnancy or immediate postpartum period.
Ultrasound
Leiomyoma with heterogeneous echogenicity.
Limited examination for characterization -> MRI
CT
Leiomyoma without enhancement after injection
MRI
MRI = modality of choice for the evaluation of degenerated leiomyomas.
Generally rounded myometrial mass with well-defined margins,
intermediate T2 hyperintensity,
persistent T1 hyperintensity on FS T1: hemorrhagic.
No enhancement after gadolinium injection
Management
Analgesic treatment in the acute phase.
Same subsequent management as for fibroids.
Differential diagnosis
Other types of degenerated leiomyomas: Decision tree on MRI according to Thomassin-Naggara: - Marked T2 hypointensity = fibroid without atypia, hyaline type. - Intermediate T2 signal: if T1 hyperintensity is hemorrhagic (persistent on FS T1) = fibroid with necrobiosis; if no T1 hyperintensity: look at the ADC: - ADC > 1.2 x 10-3: edematous fibroid - ADC - Marked T2 hyperintensity: no enhancement: cystic fibroid; enhancement: myxoid fibroid