Case reportsPatient no. I The patient, a 26-year-old black woman, gravida 1, para 1, had a normal full term vaginal delivery. Postpartum she developed a large vulval haematoma and a laparotomy was performed to exclude broad ligament haematoma. At laparotomy there were numerous small nodules on the uterine serosa. the serosa of the bowel, the omentum and parietal peritoneum. A biopsy was taken of the omentum. No uterine leiomyomata were visible.IIistological examination revealed numerous nodules in the omentum. These nodules were composed of decidua, which showed a gradual transition to interlacing smooth muscle cells in the centre of each nodule (Figs 1 and 2). The nodules were well circumscribed and partly covered by a single layer of flattened mesothelial cells. The smooth muscle cells had plump nuclei but lacked mitotic activity. A diagnosis of leiomyomatosis peritoriealis disseminata (LPD) wab made.Ultra5tructural examination of the formalinfixed tissue showed cells which had the features of smooth muscle cells (Fig. 3). The cells were elongated with oval nuclei, with a single nucleolus. Longitudinally orientated myofilanients and dense bodies as well as short profiles of rough endoplasmic reticulum were present in the cytoplasm. The cell membranes showed numerous pinocytotic vesicles. The cells were surrounded by collagen.The immediate postoperative course was uneventful: but the patient was lost to follow-up.

Ultrasonographic investigation of the various forms of chronic venous insufficiency has substantial advantages compared to diagnosis with the competing phlebogram, particularly preoperatively. Important details such as side branches in the region of the groin, course variations of the small saphenous vein and insufficiency of the perforators in the lower leg are sometimes missed in the antegrade phlebogram. However, it is absolutely necessary to take these into consideration in order to attain a substained good result of surgery. With adequate qualification of the investigator and using all ultrasound techniques, diagnosis by sonography is better than by means of antegrade phlebogram. There are clear specifications for the documentation. With regard to costs and time required, ultrasonographic investigation of chronic venous insufficiency is superior to the antegrade phlebogram and can be repeated at any time.

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