Acute abdomen by red degeneration of a parasitic leiomyoma: A case report and literature review

• Published in: Radiology case reports Vol. 19; no. 4; pp. 1533 - 1536
• Main Authors: Yoshida, Rika, Makihara, Yuko, Miyamoto, Akina, Araki, Hisatoshi, Ando, Shinji, Yoshizako, Takeshi, Oride, Aki, Kaji, Yasushi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2024; Elsevier
• Subjects: Acute abdomen; Case Report; Computed tomography; Magnetic resonance imaging; Parasitic leiomyoma; Red degeneration; Acute abdomen; Parasitic leiomyoma; Computed tomography; Magnetic resonance imaging; Red degeneration
• ISSN: 1930-0433; 1930-0433
• DOI: 10.1016/j.radcr.2024.01.031

A 43-year-old woman, with a history of uterine fibroids and multiple myomectomy, presented with acute lower abdominal pain. Computed tomography revealed multiple tumors, including a high-density mass in the left lower abdomen indicative of a parasitic leiomyoma undergoing red degeneration. This uncommon condition is due to acute occlusion, often caused by peripheral venous thrombosis at the fibroid edge. The diagnosis was corroborated by distinctive findings on magnetic resonance imaging and computed tomography. Notably, high signal intensity on T1-weighted images (T1WI) suggested methemoglobin presence due to hemorrhagic infarction, whereas low signal intensity on T2-weighted images (T2WI) indicated deoxyhemoglobin. Symptom improvement followed treatment with analgesics. This case underscores the significance of considering parasitic myomas in the differential diagnosis of intraperitoneal tumors after myomectomy and proposes that vascular torsion from mechanical stress on the mobile mesentery may contribute to red degeneration in such tumors. In this report, we detail the imaging characteristics and clinical progression of red degeneration in a parasitic leiomyoma, emphasizing the importance of this diagnosis in patients with a history of uterine surgery.