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AbdominalImaging Springer Science+Business Media Inc. 2004
Received: 5 April 2004 / Accepted: 28 April 2004 /Published online: 8 November 2004Abdom Imaging (2005) 30:120123DOI: 10.1007/s00261-004-0240-1Acute torsion of uterine leiomyoma: CT featuresC. Roy,1 G. Bierry,1 S. El Ghali,1 X. Buy,1 A. Rossini21Department of Radiology B, Surgery A, University Hospital of Strasbourg, Hopital Civil, 1, place de lHopital BP426,67091 Strasbourg Cedex, France2Department of Visceral Surgery, University Hospital of Strasbourg, Hopital Civil, 1, place de lHopital BP426,67091 Strasbourg Cedex, FranceAbstractAcute torsion of a subserosal leiomyoma is a rare acute
condition that is infrequently diagnosed preoperatively.
It is a recognized surgical emergency, especially when
additional systemic symptoms are associated. There are
two main differential diagnoses: ovary/adnexal torsion
and massive infarct inside a common leiomyoma. The
diagnosis can be established by computed tomographic
features. Ultrasound examination is less sensitive.Key words: LeiomyomaUterusTorsionUltrasound
Computed tomographyAcute torsion of a subserosal leiomyoma is a rare cause
of intense abdominal pain and a recognized surgical
emergency. It is infrequently diagnosed preoperatively.
Delay in surgery can lead to necrosis and sepsis. However, it presents a radiologic challenge. We report a case
in which the diagnosis could have been suspected by its
computed tomographic (CT) features.Case reportA 30-year-old-woman was admitted for an emergency,
acute, severe, pelvic pain associated with nausea and
frequent urination. Symptoms had begun the day before
with sudden onset and increased progressively in intensity. The patients medical and gynecologic histories were
otherwise unremarkable. Laboratory tests revealed a
mild inammatory syndrome. b-Human chorionic gonadotropin test was negative for pregnancy. At initial
physical examination, there was hypotension with
hypovolemia and fever (38C). Signs of peritoneal irritation were an intense abdominal contracture and decreased bowel tract movements, with no other
abnormality.Transabdominal ultrasound (US) showed a large,
regular, pelvic mass. It was located in the midline arising
from the pelvis to the umbilicus and was approximately
15 cm in diameter. It displaced the uterus posteriorly. It
had a heterogeneous echogenic pattern (Fig. 1A). No
blood flow was detected within the mass with color or
power Doppler sonography. The mass could not be entirely evaluated by transvaginal sonography because of
its size and position. Only a normal left ovary was seen.
A moderate amount of fluid was also present in the
pouch of Douglas. US did not show the origin...