Sobey Natasha, Raubenheimer Lauren
Department of Radiology, Inkosi Albert Luthuli Hospital, Durban, Kwa-Zulu Natal, South Africa.
Department of Radiology, Groote Schuur Hospital, University of Cape Town Medical School, Cape Town, South Africa.
SA J Radiol. 2019 Apr 18;23(1):1683. doi: 10.4102/sajr.v23i1.1683. eCollection 2019.
Uterine leiomyomas are common benign neoplasms. While generally easily diagnosed, variations in size and type of degeneration can drastically alter the imaging findings and result in diagnostic uncertainty. We present the case of a 34-year-old female with a large, cystic, pelvi-abdominal mass that was discovered in advanced pregnancy and misdiagnosed as an ovarian tumour. Intra-uterine demise of a viable foetus during an induction of labour and clinical deterioration necessitated further imaging and emergent surgical intervention. Further imaging, intra-operative findings and histopathological correlation revealed a pedunculated uterine leiomyoma with hyaline degeneration and areas of necrosis, complicated by left ovarian vein thrombosis. In addition to the intra-uterine demise, the unfortunate outcome included a total abdominal hysterectomy and unilateral salpingo-oophorectomy in a young patient. Typical leiomyomas are easily detected with imaging, however the varied clinical presentation and imaging findings in degenerating leiomyomas can prove a diagnostic challenge. This case describes a rare manifestation of a common condition and its subsequent diagnostic dilemma resulting in dire foeto-maternal outcomes.
Leiomyoma; Hypercalcaemia; Ovarian Vein Thrombosis; Pregnancy; Intra-Uterine Foetal Demise.
子宫平滑肌瘤是常见的良性肿瘤。虽然一般易于诊断，但大小和变性类型的差异可显著改变影像学表现并导致诊断不确定性。我们报告一例34岁女性病例，该患者在妊娠晚期发现盆腔腹部有一巨大囊性肿块，最初被误诊为卵巢肿瘤。引产期间活胎宫内死亡及临床病情恶化促使进一步影像学检查及紧急手术干预。进一步的影像学检查、术中发现及组织病理学关联显示为带蒂子宫平滑肌瘤伴透明变性及坏死区域，并伴有左卵巢静脉血栓形成。除了宫内胎儿死亡外，不幸的是，该年轻患者接受了全腹子宫切除术和单侧输卵管卵巢切除术。典型的平滑肌瘤通过影像学检查容易发现，然而，变性平滑肌瘤的临床表现和影像学表现各异，可能构成诊断挑战。本病例描述了一种常见疾病的罕见表现及其随后导致母婴严重不良后果的诊断困境。
平滑肌瘤；高钙血症；卵巢静脉血栓形成；妊娠；宫内胎儿死亡
