PDF(Pubmed)
Abstract：
Uterine leiomyoma should be considered when a female patient reports symptoms of abdominal pressure and abnormal vaginal bleeding. However, the symptoms of a uterine leiomyoma are vast and overlap with other possible diseases that are difficult to distinguish even with imaging studies. This is why it is important for physicians and healthcare providers to keep an open mind and have a broad differential diagnosis. In this case study, we present a 61-year-old postmenopausal female patient who presented to the emergency department with complaints of pelvic and abdominal pain, as well as vomiting and diarrhea. She was admitted for observation. A complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis revealed no abnormalities; a pelvic ultrasound and CT scan reported possible adnexal torsion. The patient remained stable and the pain had subsided when she was seen the next morning by her gynecologist (GYN) who discharged her to follow-up in the office. Subsequent examinations that aided in the diagnosis included, but were not limited to pelvic and transvaginal ultrasounds, an abdominal and pelvic CT, and a pelvic MRI. In this case, the MRI revealed an 11-cm mass that could represent a torsioned pedunculated necrotic fibroid originating from the uterus. Radiology recommended surgical removal. Upon removal and review of the pathology of the mass, it was revealed to be a torsioned, partially necrotic fibroma that had originated from the ovary and not from the uterus, as imaging had originally suggested.
摘要：
当女性患者报告腹压和阴道异常出血的症状时，应考虑子宫平滑肌瘤。然而,子宫平滑肌瘤的症状非常广泛，并且与其他可能的疾病重叠，即使通过影像学检查也很难区分。这就是为什么医生和医疗保健提供者保持开放的心态并进行广泛的鉴别诊断很重要。在这个案例研究中,我们介绍了一名61岁的绝经后女性患者，她到急诊科就诊，主诉盆腔和腹部疼痛，还有呕吐和腹泻.她被接纳接受观察。全血细胞计数（CBC），综合代谢小组(CMP)，尿液分析未见异常；盆腔超声和CT扫描报告可能存在附件扭转。患者保持稳定，当她的妇科医生（GYN）第二天早上看到她时，疼痛已经减轻，她出院后在办公室进行随访。有助于诊断的后续检查包括，但不仅限于盆腔和经阴道超声检查，腹部和盆腔CT,和骨盆MRI.在这种情况下,MRI显示一个11厘米的肿块，可能代表源自子宫的扭转带蒂坏死纤维瘤。放射学建议手术切除。在移除和检查肿块的病理后，它被发现是一个扭曲的，起源于卵巢而非子宫的部分坏死性纤维瘤，正如影像学最初建议的那样。
