Role of dynamic MRI in surgical decision-making for a postpartum woman with a prolapsed degenerating uterine leiomyoma.

Background: Surgical decision-making in the case of postpartum complications affecting fibroids can be difficult. We present a case that illustrates the potential role of MRI in assisting these decisions.

Case: A 28-year-old woman with a known uterine leiomyoma presented on postpartum day 10 with abdominal pain, fever, and foul-smelling vaginal discharge. Her condition improved after antibiotic therapy, but she subsequently returned to hospital with a liquefied fibroid filling the vagina and a solid mass palpable above the dilated cervix. Pelvic ultrasound did not conclusively identify the vascular supply or myometrial involvement of the mass. MRI identified one fundal vascular pedicle and a very thin posterior uterine wall. At abdominal myomectomy, the myometrium was found to be only minimally involved, and the fundal vascular pedicle was easily cross-clamped.

Conclusion: When available, MRI can be used to clarify the location of vascular pedicles and the extent of myometrial involvement of uterine fibroids, and it can assist in fibroid-related surgical decision-making.