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Answer: Uterine Leiomyomata.

Findings:

MRI of the pelvis demonstrates an enlarged uterus with multiple uterine leiomyomata, or fibroids, predominantly in subserosal location. Two distinct dominant fibroids are seen involving the ventral and dorsal aspects of the uterus. These both have broad based attachments.

Discussion:

Uterine leiomyomata, or uterine fibroids, are non-cancerous growths that develop in the muscular wall of the uterus.

Fibroids are the most common tumor of the female reproductive system, occurring in up to 20-40% of women, and more common in African American females.

Most fibroids are asymptomatic.

Fibroids can cause excessive menstrual bleeding that affects quality of life and can result in significant anemia.

Other manifestations may be related to bulk, i.e. cyclical pain and pressure, abdominal bloating and distention, urinary frequency, constipation, painful intercourse, and infertility.

Fibroids can also dramatically increase in size during pregnancy. This is thought to occur secondary to increase in estrogen levels during pregnancy.

Fibroids are the most frequent indication for hysterectomy in premenopausal women.

Diagnosis:

The gynecologist typically performs an ultrasound examination in the office to confirm the suspicion of fibroids and to follow their growth.

MRI is an important diagnostic test for patients who may be candidates for uterine fibroid embolization (UFE) as it precisely determines the size, number and location of the fibroids. It can also identify other causes of the patient's symptoms (i.e. adenomyosis, endometriosis, and other extra-uterine pathology).

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