Diagnostic ultrasound ( PDFDrive )

CHAPTER 15 The Uterus 539
A
B
C
D
E
F
G H I
FIG. 15.11 Leiomyomas, Variable Appearances. (A) Sagittal TVS shows a hypoechoic subserosal leiomyoma (arrow). (B) Transverse TAS
demonstrates a heterogeneous hypoechoic intramural ibroid (calipers). (C) Sagittal TVS shows a hypoechoic submucosal leiomyoma, almost entirely
within the endometrial cavity. (D) TAS with color Doppler imaging shows vessels connecting the ibroid (F) to the uterus (U), conirming a
pedunculated subserosal leiomyoma. (E) TVS of a leiomyoma with globular calciication with shadowing. (F) Sagittal TAS image of a leiomyoma
with peripheral calciication. (G) Transverse TVS shows a hyperechoic mass, typical of a lipoleiomyoma. (H) Sagittal TVS demonstrates a leiomyoma
with cystic degeneration. When pedunculated from the uterus, such a leiomyoma can be mistaken for an ovarian mass. See also Video 15.3. (I)
Sagittal TVS from a sonohysterogram shows the endometrium (arrow) overlying the submucosal ibroid. Note the balloon catheter (B).
because when ibroids are more than 50% within the endometrial
cavity, they can frequently be removed hysteroscopically.
he location of some leiomyomas spans several of these more
general groups, and a more detailed classiication of leiomyoma
location has been suggested. 75,76 hus when ibroids are seen to
distort the endometrium, it is frequently helpful to estimate the
percentage within the endometrial cavity in addition to using
whatever classiication system is preferred by the referring
clinicians. Although TVS is oten adequate when ibroids are
small and/or few in number, it is important to also assess the
patient with TAS. Large ibroids, ibroids located superiorly in
an enlarged uterus, or pedunculated subserosal leiomyomas
may be incompletely seen or entirely overlooked if only TVS
is performed.