Intramural fibroid

Intramural fibroids are the most common type of fibroids. Their blood supply comes from one or more nutrient arteries. As the fibroid increases in size, the nutrient artery, and the arcuate artery enlarge [4]. Submucosal fibroids also obtain their blood supply from the nutrient arteries. However, with subserosal fibroids, the fibroid may adhere to other structures, and derive blood supply from those adjacent structures [4], including the ovarian arteries. 

Fig. 10.4.2a,b. A 45-year-old woman with fibroid-related menorrhagia, a Pre-embolization sagittal contrast-enhanced MRl shows a single hypervascular intramural fibroid (F). b Post-embolization contrast-enhanced MRl obtained 3 months after embolization demonstrates a complete devascularization of the embolized fibroid with a normal myometrial perfusion The patient s condition has also greatly improved... 

Fig.10.5. 4a-f. A 37-year-old patient with heavy bleeding related to a 7-cm intramural fibroid. a,b Right uterine artery angiogram demonstrates spasm (arrow) due to catheterization, c Left uterine artery angiogram shows the feeding artery to the fibroid (arrow), d Embolization of the main feeding artery and patency of the myometrial arteries, e MRI obtained prior to the embolization shows a large intramural mass, f MRI obtained 10 months after the embolization shows an almost normal uterus... 

Depending on their location, leiomyomas can be resected or enucleated using a hysteroscopic or laparoscopic access or open laparotomy. Hysteroscopic resection is suitable to remove submucosal leiomyomas. Hysteroscopic resection is generally considered unsuitable for submucosal leiomyomas larger than 5 cm in size, if more than three fibroids are present, or if the uterine cavity is very large (length of uterine probe > 12 cm). Moreover, the size of the intramural... 

Magnetic resonance imaging (MRl) is the most accurate diagnostic modality for assessing uterine leiomyomas [37]. MRI enables assessment of the uterus in multiplanar orientation and without interference from superimposed structures. MRI provides not only accurate information on the number and size of fibroids but also on their location within the uterus (cervix, corpus, fundus) and within the wall (submucosal, intramural. 

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