CT features for diagnosing acute torsion of uterine subserosal leiomyoma

Ohgiya, Yoshimitsu; Seino, Noritaka; Miyamoto, Shingo; Takeyama, Nobuyuki; Hatano, Kumi; Munechika, Jiro; Ishizuka, Kosuke; Hirose, Masahiro; Ohike, Nobuyuki; Hashimoto, Toshi; Sekizawa, Akihiko; Gokan, Takehiko

doi:10.1007/s11604-017-0712-1

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…Contrast-enhanced CT may be helpful for identification of uterine fibroids that have undergone torsion or necrosis [12,17], with the findings of diminished contrast enhancement of the fibroid(s) (86% sensitivity) and ascites (100% sensitivity) demonstrating the best diagnostic performance in a series of 51 cases [18]. CT is also helpful in evaluation of fibroids when calcified masses cause shadowing and limit visualization of the pelvic contents by US [19].…”

Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain

Gyn¹,

Imaging

Henrichsen

et al. 2021

Journal of the American College of Radiology

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Acute pelvic pain is a common presenting complaint in both the emergency room and outpatient settings. Pelvic pain of gynecologic origin in postmenopausal women occurs less frequently than in premenopausal women; however, it has important differences in etiology. The most common causes of postmenopausal pelvic pain from gynecologic origin are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm. Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems. As the optimal imaging modality varies for these etiologies, it is important to narrow the differential diagnosis before choosing the initial diagnostic imaging examination. Transabdominal and transvaginal ultrasound are the best initial imaging techniques when the differential is primarily of gynecologic origin. CT with intravenous (IV) contrast is more useful if the differential diagnosis remains broad. MRI without IV contrast or MRI without and with IV contrast, as well as CT without IV contrast may also be used for certain differential considerations.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Procedures By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Postmenopausal Acute Pelvic Pain

Gyn¹,

Imaging

Henrichsen

et al. 2021

Journal of the American College of Radiology

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“…These findings are attributed to blood flow blockage from the feeding vessel by pedicle torsion. The finding with the highest diagnostic sensitivity was ascites (100%), while the highest specificity was a dark fan sign (100%) 1) . In the present case, all specific imaging findings (poor contrast enhancement, thin rim enhancement, dark fan sign, and ascites) were observed.…”

Section: Discussionmentioning

confidence: 99%

“…The contrastenhanced CT findings are useful to diagnose torsion of subserosal fibroids. These fibroids have some specific features, such as poor contrast enhancement inside the fibroid, a thin rim enhancement, dark fan sign, (fanshaped poor contrast enhancement in the uterine area adjacent to the subserosal fibroid), and ascites in the pelvic cavity 1) . These findings are attributed to blood flow blockage from the feeding vessel by pedicle torsion.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is necessary to exclude appendicitis, Successful management of preoperatively diagnosed torsion of a subserosal uterine fibroid by pneumoperitoneum laparoscopic singleport surgery gastroenteritis, torsion of ovarian tumor, pelvic inflammatory disease, ectopic pregnancy, ovarian bleeding, etc. Even when the symptom is due to uterine fibroids, the pain is mostly caused by red degeneration of fibroids 1,2) . Medical history and pregnancy tests are important, and imaging modalities, such as CT, are decisive factors in the diagnosis of torsion of fibroids.…”

Section: Discussionmentioning

confidence: 99%

“…Uterine fibroids are benign gynecological neoplasms found in 20 -30% of reproductiveaged women 1) . Most fibroids are asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

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