Findings: Image #1 is an axial post contrast enhanced image of the mid abdomen which demonstrates right hydronephrosis.
Image #2 is an image through the pelvis, which demonstrates a large heterogeneous mass which occupies the entire pelvis. The mass has central regions of decreased attenuation. Also note the right hydroureter.
Diagnosis: Huge uterine leiomyoma with hydronephrosis. Discussion: Uterine leiomyomas (fibroids) occur in approximately 20% - 50% of women. They generally arise from the smooth muscle of the uterine wall and may be located intramural (within the myometrium), subserosal (beneath the peritoneum), or submucosa (adjacent to the endometrium). Although the majority are asymptomatic, symptoms are highly dependent upon size and location. Potential symptoms range from bleeding to infertility as well as dysmenorrhea, dysuria, and constipation. In addition, obstructive uropathy may develop (as was seen in this case). The ultrasound characteristics of uterine leiomyomas (fibroids) may be homogeneous or heterogeneous, hypoechoic or hyperechoic.
CT characteristics of uterine leiomyomas consist of an enlarged uterus with a deformed uterine contour. They are most commonly uniformly solid density, but necrosis may occur which would alter the density (such as was seen in this case). In addition, calcifications are quite common (approximately 10% of cases), and are the most specific sign of leiomyoma. On rare occasions, leiomyoma may undergo malignant degeneration to leiomyosarcomas, but this is estimated to occur in less than 1% of cases. Treatment is based on clinical symptoms.
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