Clinical Images  |   July 2018
Massively Enlarged Leiomyomatous Uterus
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Daniel Martingano, DO, New York University Langone Hospital - Brooklyn, Department of Obstetrics and Gynecology, 150 55th St, Brooklyn, NY 11220-2508. Email:
Article Information
Imaging / Obstetrics and Gynecology / Clinical Images
Clinical Images   |   July 2018
Massively Enlarged Leiomyomatous Uterus
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 493. doi:
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 493. doi:
A 37-year-old woman, gravida 3, para 3, presented with complaints of pelvic pressure, heavy bleeding, and pain with menses. Symptoms were unresponsive to a levonorgestrel intrauterine system and uterine artery embolization. A large, globular uterus was noted on pelvic examination. Computed tomographic (CT) images demonstrated a massively enlarged leiomyomatous uterus extending into the abdomen at the base of the stomach (image A). The uterus measured 18 × 16 cm with a subserosal leiomyoma (11 × 10 cm) at the uterine fundus. The patient underwent a total abdominal hysterectomy. Gross examination of the leiomyomatous uterus revealed a 30-week gestational-sized uterus with multiple leiomyomas and a 10-week sized subserosal leiomyoma at the fundus (image B). 
Uterine leiomyomas, or fibroids, are the most common pelvic tumors in women.1 The presumptive diagnosis is usually based on the finding of an enlarged, mobile uterus with an irregular contour on bimanual pelvic examination. Ultrasonography is used to confirm the diagnosis, but larger masses may require CT or magnetic resonance imaging.2 
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-107. [CrossRef] [PubMed]
Buttram VCJr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36(4):433-435. [CrossRef] [PubMed]