Interactive Transcript
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Our next case is of a 52-year-old.
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She was diagnosed with a fibroid on an outside
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hospital ultrasound, which you can see here.
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Just giving you the cine clips through it.
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They threw some measurement calipers on this
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structure, and it was called a large fibroid.
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Because she was having pain and
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discomfort from this, she was referred
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to a pre-EMBO evaluation via MRI.
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Before we go to that, you already know
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you're in the adenomyosis portion of
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this, so some of the features you can look
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for in this that tell you that it is not
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actually a fibroid, or can at least make
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you think maybe, maybe not type of thing.
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We do have some well-defined borders,
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so that can certainly push you towards fibroid.
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But we do also have venetian blind sign
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right here, and we have a lot of it.
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The other thing that threw me off from
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fibroid is fibroid is a mass-like process.
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Here's your endometrium right here and you
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have this on both sides of the endometrium.
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So fibroid can't really
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span the endometrium, again,
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anterior and posterior round, almost
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wrapping around the endometrium.
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Fibroids can't do that.
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So it should make you start to think that maybe
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this isn't a fibroid, maybe it's something else.
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So in this case, the MRI is performed for
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preoperative embolization purposes,
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but also for diagnostic purposes as well.
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So here's our preoperative MRI.
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Again, the sagittal is a little bit
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limited by respiratory motion,
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but it's still more than diagnostic.
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So we can already see, too, again,
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confirms the ultrasound findings.
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We have a very large uterus, quite globular,
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very rounded, globe-like, if you will.
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Here's your very thin endometrium.
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And you can already see this process
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is pretty symmetric on both sides
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of the endometrium right here.
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We don't have any well-
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defined borders at this point.
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You can sort of see where we have
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some maybe normal myometrium,
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but it just sort of blends in.
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We definitely have T2 bright foci
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as well as we go through this.
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The coronal image, you don't have nearly as
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much motion problems or respiratory issues
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here, so you can see it a little bit better.
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Again, endometrium right here centrally
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pushed off maybe a little bit to the left,
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but this sort of ill-defined T2 dark structure
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with lots of T2 bright foci within it.
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And here's your axial, you can see even sort
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of pushes the endometrium off to the right here.
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And you can see T2 bright foci, this ill-defined
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mass-like structure that enlarges the ovary.
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Non-mass, like in the sense that there's no
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well-defined borders, this is adenomyosis.
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And just another little fun finding in your
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pre-contrast T1, you can actually see some of
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the little hemorrhagic deposits because this is
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endometrial tissue, so it can absolutely bleed.
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Sometimes it can get stuck behind there
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and you have these little bright foci of blood products within them.
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So this ended up not being a fibroid,
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so they didn't necessarily
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a uterine artery embolization to treat
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a fibroid because it's not a fibroid.
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You can do UAE for adenomyosis, may not be
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quite as effective in symptom management,
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depending on what your symptoms were
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as it is for fibroids, but it'd be
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something to consider and to talk about.
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Other thing you could think about in this
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particular case, you know, could this
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be some sort of uterine carcinoma here?
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I would argue it's very
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respectful of that endometrium.
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It doesn't really pushes it away.
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It doesn't narrow.
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It's not irregular.
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And in this particular case, these studies
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were nearly a year apart from her oldest study.
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So this was stable.
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So we knew this wasn't a uterine carcinoma
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or sarcoma, something like that,
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but this was just plain adenomyosis,
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just a very large fragment of it.
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