MR imaging findings of uterine pyomyoma: radiologic–pathologic correlation

Abstract

A 69-year-old postmenopausal female with a spontaneously occurring uterine pyomyoma was described with emphasis on the MR imaging findings. On unenhanced T1- and T2-weighted MR images, a huge mottled mass suspected to contain blood products, necrotic tissue, or purulent or viscous fluid was demonstrated within anterior myometrial wall of uterine body. The mass was surrounded by a peripheral rim that was hyperintense on T1-weighted images and hypointense on T2-weighted images. On gadolinium-enhanced MR images, most of the mass was unenhanced, but the peripheral rim was equally enhanced with the surrounding myometrium. Pathological examination revealed an intramural uterine pyomyoma surrounded by fibrous capsules with abundant lymphocytes and neutrophils. Our findings indicate that pyomyoma should be considered when MR images demonstrate a myometrial cystic lesion accompanied by a peripheral rim.

Pyomyoma Following Uterine Artery Embolization (UAE) – Dual Case Report and Review of Literature

“…Pyomyoma (suppurative leiomyoma) results from infarction, necrosis, and infection of the leiomyoma [1,[3][4][5][11][12][13][14][15][16]. Pyomyoma is a rare occurrence in the post-antibiotic era.…”

Spontaneous Ruptured Pyomyoma in a Nulligravid Female: A Case Report and Review of the Literature

“…Pyomyoma, or suppurative leiomyoma, is a rare condition that occurs with infection of a leiomyoma. The infected leiomyoma generally shows suppurative inflammation, containing pus with neutrophils and necrotic exudate [ 3 ]. Most cases in premenopausal women occur during pregnancy or the immediate postpartum period, after uterine instrumentation [ 3 ], or as a result of cervical stenosis [ 4 ].…”

“…The infected leiomyoma generally shows suppurative inflammation, containing pus with neutrophils and necrotic exudate [ 3 ]. Most cases in premenopausal women occur during pregnancy or the immediate postpartum period, after uterine instrumentation [ 3 ], or as a result of cervical stenosis [ 4 ]. Only four cases have been reported as being diagnosed during pregnancy [ 5 ].…”

“…Only four cases have been reported as being diagnosed during pregnancy [ 5 ]. Cases in postmenopausal women are likely the result of immune or vascular compromise, such as in the setting of diabetes, hypertension, or atherosclerotic disease [ 3 ]. Infections are generally polymicrobial and are thought to arise from the lower genital tract, by direct spread—for example, by contact with the endometrial cavity in a C-section [ 6 ]—or by hematogenous/lymphatic spread [ 1 , 3 , 7 ].…”

“…Cases in postmenopausal women are likely the result of immune or vascular compromise, such as in the setting of diabetes, hypertension, or atherosclerotic disease [ 3 ]. Infections are generally polymicrobial and are thought to arise from the lower genital tract, by direct spread—for example, by contact with the endometrial cavity in a C-section [ 6 ]—or by hematogenous/lymphatic spread [ 1 , 3 , 7 ]. Cases in the immediate postpartum period or after uterine instrumentation, e.g., after a D&C, are thought to be most likely the result of ascending infection [ 1 ].…”