Uterine leiomyomas commonly undergo degenerative change, which can lead to variable imaging features. Diffuse hydropic change is an unusual form of degeneration that presents a considerable diagnostic challenge to both radiologists and pathologists, as it can mimic a malignant neoplasm on imaging and at histological analysis. We present the case of a giant diffuse hydropic leiomyoma presenting in the first trimester of pregnancy in a 36-year-old woman, the imaging features of which were suggestive of a more aggressive neoplasm. The sonographic and MRI appearances of the lesion are discussed, and the varied imaging features of leiomyomas are reviewed.
In the cases of vertical retraction syndromes previously reported in the literature, the "leash effect" of vertical recti was responsible for a limitation of motility and for retraction in up- or down-gaze. This vertical retraction syndrome mimics Duane's syndrome and benefits from recession of the taut vertical recti. In the case reported, another mechanism had led to vertical retraction syndrome. In a bilateral horizontal Duane's syndrome, the physiological co-contraction of abnormally short horizontal recti in vertical gaze was responsible for vertical retraction syndrome and even for a positive vertical forced duction test. The vertical motility was returned to normal by recession of the four horizontal recti.
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