Uterineleiomyomas or uterine fibroids are the most common gynaecological tumours andoccur in about 20-50% of women around the world. Ultrasonography (USG) is the first-line imagingexamination in suspected fibroids and shows high sensitivity and specificity indiagnosing this condition. Ultrasound scanscan be performed transvaginally (transvaginal scan – TVS) ortransabdominally (transabdominal scan – TAS); both scans have advantages andlimitations, but, in general, transvaginal sonography is superior totransabdominal sonography in most cases of pelvicpathology. Whether a leiomyoma is symptomaticor not depends primarily on its size and location. During ultrasound examination, leiomyomas usually appear as well-defined,solid, concentric, hypoechoic masses that cause a variable amount of acousticshadowing. During the examination of leiomyomas differential diagnosis isimportant. Some of the most common misdiagnosed pathologies are adenomyosis,solid tumours of adnexa, and endometrial polyps.
Thefollowing table describes the differentiating features between fibroid andadenomyosis.
Feature Typicalfibroid Adenomyosis
Serosalcontour of uterus Lobulated orregular Often globally enlarged uterus
Definitionoflesion Well‐defined Ill‐definedin diffuse adenomyosis (adenomyoma may be well‐defined)
Symmetryof uterine walls Asymmetrical in presence ofwell‐defined lesion(s) Myometrial anteroposteriorasymmetry
Lesion
Outline Well‐defined Ill‐defined
Shape Round,oval, lobulated Ill‐defined
Contour Smooth Irregularor ill‐defined
Rim Hypo‐or hyperechogenic No rim
Shadowing Edgeshadows, internal shadows (often fan‐shapedshadowing) No edge shadows, fan‐shaped shadowing67
