James Spies, M.D.
Georgetown University Medical Center
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James Spies, M.D. Georgetown University Medical Center |
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A 39-year-old woman presented with menorrhagia and severe menstrual cramping. She had an MRI, which revealed on sagittal scans a dominant intramural fibroid, with a portion abutting and distorting the endometrium (Figure 1). The patient underwent uterine embolization and her symptoms were controlled with the first menstrual period. Three months after the procedure, the patient developed progressive cramping and pain in her pelvis. She had no fever and other than the cramps she felt well. The cramps did not subside for several days and she began to pass small to moderate-sized pieces of tissue vaginally. |
 Fig. 1. MRI sagittal scan shows a dominant intramural fibroid with a portion abutting and distorting the endometrium. |
| This continued for two more days without relief of her symptoms. The patient still had no clinical signs of infection. An MRI was done, which showed that the entire fibroid, which had been intramural was now intra-cavitary. The patient was then referred to her gynecologist for hysteroscopic resection. On examination, the cervix was dilated. The fibroid was removed with hysteroscopic resection as an outpatient and the patient has done well with no further symptoms.
Question? What is the best management for a patient passing a fibroid? Related Cases: Case 1199_02 -- Expulsion of a Large Fibroid Post Uterine Artery Embolization |
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