FIBROID

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FIBROID

FIBROID

Uterine leiomyomas or uterine fibroids are the most common gynaecological tumours and occur in about 20-50% of women around the world. Ultrasonography (USG) is the first-line imaging examination in suspected fibroids and shows high sensitivity and specificity in diagnosing this condition. Ultrasound scans can be performed transvaginally (transvaginal scan – TVS) or transabdominally (transabdominal scan – TAS); both scans have advantages and limitations, but, in general, transvaginal sonography is superior to transabdominal sonography in most cases of pelvic pathology. Whether a leiomyoma is symptomatic or not depends primarily on its size and location. During ultrasound examination, leiomyomas usually appear as well-defined, solid, concentric, hypoechoic masses that cause a variable amount of acoustic shadowing. During the examination of leiomyomas differential diagnosis is important. Some of the most common misdiagnosed pathologies are adenomyosis, solid tumours of adnexa, and endometrial polyps.

The following table describes the differentiating features between fibroid and adenomyosis.

Feature                Typical fibroid                 Adenomyosis

Serosal contour of uterus    Lobulated or regular     Often globally enlarged uterus

Definition of lesion      Well‐defined    Ill‐defined in diffuse adenomyosis (adenomyoma may be well‐defined)

Symmetry of uterine walls    Asymmetrical in presence of well‐defined lesion(s)    Myometrial anteroposterior asymmetry

Lesion

Outline    Well‐defined    Ill‐defined

Shape    Round, oval, lobulated    Ill‐defined

Contour    Smooth    Irregular or ill‐defined

Rim    Hypo‐ or hyperechogenic    No rim

Shadowing    Edge shadows, internal shadows (often fan‐shaped shadowing)    No edge shadows, fan‐shaped shadowing67

 

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