Massively Enlarged Leiomyomatous Uterus
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Daniel Martingano
A 37-year-old woman, gravida 3, para 3, presented with complaints of pelvic pressure, heavy bleeding, and pain with menses. Symptoms were unresponsive to a levonorgestrel intrauterine system and uterine artery embolization. A large, globular uterus was noted on pelvic examination. Computed tomographic (CT) images demonstrated a massively enlarged leiomyomatous uterus extending into the abdomen at the base of the stomach (image A). The uterus measured 18 × 16 cm with a subserosal leiomyoma (11 × 10 cm) at the uterine fundus. The patient underwent a total abdominal hysterectomy. Gross examination of the leiomyomatous uterus revealed a 30-week gestational-sized uterus with multiple leiomyomas and a 10-week sized subserosal leiomyoma at the fundus (image B).
Uterine leiomyomas, or fibroids, are the most common pelvic tumors in women.1 The presumptive diagnosis is usually based on the finding of an enlarged, mobile uterus with an irregular contour on bimanual pelvic examination. Ultrasonography is used to confirm the diagnosis, but larger masses may require CT or magnetic resonance imaging.2
References
1. Baird DD , DunsonDB, HillMC, CousinsD, SchectmanJM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-107.10.1067/mob.2003.99Suche in Google Scholar
2. Buttram VC Jr , ReiterRC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433-435.10.1016/S0015-0282(16)45789-4Suche in Google Scholar
© 2018 American Osteopathic Association
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Artikel in diesem Heft
- LETTERS TO THE EDITOR
- Response
- OMT MINUTE
- Osteopathic Lymphatic Pump Techniques
- STILL RELEVANT?
- The Rule of the Artery Is Supreme. Or, Is It?
- LETTERS TO THE EDITOR
- Progressive Infantile Scoliosis Managed With Osteopathic Manipulative Treatment
- AOA COMMUNICATION (REPRINT)
- Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
- Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
- ORIGINAL CONTRIBUTION
- Medical Students’ Knowledge, Attitudes, and Behaviors With Regard to Skin Cancer and Sun-Protective Behaviors
- Lymphatic Pump Treatment Mobilizes Bioactive Lymph That Suppresses Macrophage Activity In Vitro
- JAOA/AACOM MEDICAL EDUCATION
- Oral Health Training in Osteopathic Medical Schools: Results of a National Survey
- CASE REPORT
- Perplexing Rash: Challenges to Diagnosis and Management of Mycosis Fungoides
- Laparoscopic Adjustable Gastric Band Erosion Into the Stomach and Colon
- THE SOMATIC CONNECTION
- Safety of Chiropractic Manipulation in Patients With Migraines
- Effect of HVLA on Chronic Neck Pain and Dysfunction
- Effects of Adding Cervicothoracic Treatments to Shoulder Mobilization in Subacromial Impingement Syndrome
- Manipulation Under Anesthesia Thaws Frozen Shoulder
- Treating Patients With Low Back Pain: Evidence vs Practice
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- Neuromuscular Manipulation Improves Pain Intensity and Duration in Primary Dysmenorrhea
- Reducing Cesarean Delivery Rates and Length of Labor by Addressing Pelvic Shape
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- CLINICAL IMAGES
- Minocycline-Induced Hyperpigmentation
- Massively Enlarged Leiomyomatous Uterus
