Presentation
Abnormal vaginal bleeding.
Patient Data
Large well-defined pedunculated mass arising from the posterior uterine wall, well-demonstrated on sagittal and coronal T2 sequences, and prolapsing into a distended vagina. It appears isointense to the myometrium on T1 and hypointense on T2, with central areas of high signal (cystic degeneration/necrosis) and moderate heterogeneous enhancement on postcontrast sequences.
Thickening of the junctional zone (17 mm) of intermediate signal intensity on T1 and homogeneous low signal intensity on T2 is in keeping with diffuse adenomyosis with small intramural uterine leiomyomas.
Blood-filled, distended upper vagina.
Case Discussion
The MRI features are most consistent with pedunculated uterine leiomyomas prolapsing into the vagina.
MRI is the most reliable imaging technique for the detection of uterine leiomyomas and rule out in such case, a prolapsed endometrial polyp or neoplasm of the cervix extending to the upper vagina.
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