Submucosal fibroid

Fig. 10.2.1a,b. Sonographic appearance of a submucosal fibroid, a A well circumscribed hypoechoic round mass with some internal heterogeneity is characteristic of a leiomyoma, b Doppler can be used to show the hypervascularity of this benign tumor... 

The mechanism by which fibroids cause abnormal uterine bleeding is not known. However, there have been several theories proposed. One theory claims that the increase in size of the endometrial surface area causes the bleeding and is therefore most pertinent to submucosal fibroids [91]. The increased vascularity and vascular flow to the uterus as a result of fibroids has also been held responsible... 

Another theory describes the ulceration of a submucosal fibroid into the endometrial surface [91]. The fibroids may compress the venous plexus within the myometrium which may lead to uterine engorgement and greater bleeding [91]. The latest... 

One of the first details noted is the location of the fibroid. A 31-patient study showed that submucosal fibroids displayed 30%-40% greater reduc-... 

Berkowitz RP, Hutchins FL Jr et al (1999) Vaginal expulsion of submucosal fibroids after uterine artery embolization. A report of three cases. J Reprod Med 44 373-376... 

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. 

A reported complication after uterine artery embolization has been a persistent vaginal discharge [86]. This discharge, which is often characterized as brown or red-brown in color, can begin within days of the embolization procedure and can potentially last for several months [7]. Vaginal discharge may be more frequent in patients with submucosal fibroids or when embolization of the uterine arteries to stasis has been performed (Fig. 10.4.8) [7,53]. 

Fig. 10.4.10a,b. A 45-year-old woman with complete resolution of symptoms after embolization, a Pre-embolization sagittal T2-weighted MRI shows a small pedunculated submucosal fibroid (F). She underwent a failed attempt of hysteroscopic resection prior to embolization, b At 3-months post-embolization MRI shows that the whole fibroid has been spontaneously expelled. The uterus is virtually normal... 

Fibroid location within the uterus may influence the outcome of embolization. Submucosal fibroids were more likely to respond to UFE [20]. Submucosal location was a positive predictor of fibroid volume reduction after UFE [21]. The subserosal fibroids are also believed to be associated with less volume reduction after embolization (Fig. 10.5.6). 

SSG utilizes transvaginal sonography during instillation of either saline or contrast medium into the uterine lumen. It is best performed after sono-hysterography, since sonohysterography is vital in delineating the endometrial surfaces for presence of synechiae or intraluminal lesions such as polyps or submucosal fibroids. 

---