Abdomen : Case 5

History :  A 52-year-old male with abdominal discomfort

What is the abnormality?

A. Bladder stone
B. Calcified uterine myoma
C. Calcified node
D. Artifact

Answer : B . Calcified uterine myoma or calcified fibroid

Uterine Myoma:
 

• Benign tumors of smooth muscle origin
• 20-50% of women > 30 years of age
• Fibroids may enlarge with elevated estrogen levels such as during the first trimester of pregnancy
• Uterine fibroids diminish in size after menopause

Clinical Findings :

• Most : Asymptomatic
• Symptoms can include : Menorrhagia, pain, urinary frequency, urgency, incontinence or Infertility 

Imaging Findings : Ultrasound is the study of choice

• Ultrasound
  • Echogenic mass if fibrosis prevails
  • Hypoechoic, solid mass if muscle component is prevalent
  • Sharp discrete shadows
  • Anechoic features if central portion of fibroid has degenerated

• Conventional radiography :
  • Soft tissue mass arising from the pelvis but separate from the urinary bladder
  • Amorphous, flocculent calcifications in the pelvis
    • May resemble “popcorn” or may calcify the outer rim of fibroid
  • Displacement of bowel gas up and out of the pelvis

Complications :

• Rarely (< 1%), malignant degeneration to a leiomyosarcoma
• Exophytic fibroid can torse and cause pain
• Infertility from interference with implantation
• During pregnancy< >Spontaneous abortionIntrauterine growth retardation
• Postpartum hemorrhage