0:01

Our next case is of a 52-year-old.

0:04

She was diagnosed with a fibroid on an outside

0:06

hospital ultrasound, which you can see here.

0:09

Just giving you the cine clips through it.

0:11

They threw some measurement calipers on this

0:13

structure, and it was called a large fibroid.

0:16

Because she was having pain and

0:17

discomfort from this, she was referred

0:19

to a pre-EMBO evaluation via MRI.

0:24

Before we go to that, you already know

0:25

you're in the adenomyosis portion of

0:27

this, so some of the features you can look

0:29

for in this that tell you that it is not

0:30

actually a fibroid, or can at least make

0:32

you think maybe, maybe not type of thing.

0:35

We do have some well-defined borders,

0:37

so that can certainly push you towards fibroid.

0:39

But we do also have venetian blind sign

0:42

right here, and we have a lot of it.

0:44

The other thing that threw me off from

0:45

fibroid is fibroid is a mass-like process.

0:48

Here's your endometrium right here and you

0:50

have this on both sides of the endometrium.

0:53

So fibroid can't really

0:54

span the endometrium, again,

0:56

anterior and posterior round, almost

0:57

wrapping around the endometrium.

0:59

Fibroids can't do that.

1:00

So it should make you start to think that maybe

1:02

this isn't a fibroid, maybe it's something else.

1:05

So in this case, the MRI is performed for

1:07

preoperative embolization purposes,

1:09

but also for diagnostic purposes as well.

1:13

So here's our preoperative MRI.

1:15

Again, the sagittal is a little bit

1:16

limited by respiratory motion,

1:18

but it's still more than diagnostic.

1:21

So we can already see, too, again,

1:22

confirms the ultrasound findings.

1:23

We have a very large uterus, quite globular,

1:26

very rounded, globe-like, if you will.

1:29

Here's your very thin endometrium.

1:31

And you can already see this process

1:32

is pretty symmetric on both sides

1:35

of the endometrium right here.

1:37

We don't have any well-

1:38

defined borders at this point.

1:40

You can sort of see where we have

1:41

some maybe normal myometrium,

1:43

but it just sort of blends in.

1:45

We definitely have T2 bright foci

1:47

as well as we go through this.

1:49

The coronal image, you don't have nearly as

1:52

much motion problems or respiratory issues

1:55

here, so you can see it a little bit better.

1:56

Again, endometrium right here centrally

1:58

pushed off maybe a little bit to the left,

2:00

but this sort of ill-defined T2 dark structure

2:03

with lots of T2 bright foci within it.

2:07

And here's your axial, you can see even sort

2:10

of pushes the endometrium off to the right here.

2:16

And you can see T2 bright foci, this ill-defined

2:18

mass-like structure that enlarges the ovary.

2:21

Non-mass, like in the sense that there's no

2:23

well-defined borders, this is adenomyosis.

2:25

And just another little fun finding in your

2:27

pre-contrast T1, you can actually see some of

2:30

the little hemorrhagic deposits because this is

2:33

endometrial tissue, so it can absolutely bleed.

2:35

Sometimes it can get stuck behind there

2:37

and you have these little bright foci of blood products within them.

2:42

So this ended up not being a fibroid,

2:46

so they didn't necessarily

2:48

a uterine artery embolization to treat

2:49

a fibroid because it's not a fibroid.

2:52

You can do UAE for adenomyosis, may not be

2:56

quite as effective in symptom management,

2:58

depending on what your symptoms were

3:00

as it is for fibroids, but it'd be

3:02

something to consider and to talk about.

3:05

Other thing you could think about in this

3:06

particular case, you know, could this

3:08

be some sort of uterine carcinoma here?

3:11

I would argue it's very

3:12

respectful of that endometrium.

3:14

It doesn't really pushes it away.

3:15

It doesn't narrow.

3:16

It's not irregular.

3:18

And in this particular case, these studies

3:19

were nearly a year apart from her oldest study.

3:22

So this was stable.

3:23

So we knew this wasn't a uterine carcinoma

3:26

or sarcoma, something like that,

3:28

but this was just plain adenomyosis,

3:31

just a very large fragment of it.