A 29-year-old woman at 14 weeks gestation presents with acute pain and localised tenderness over a known 6 cm uterine fibroid. Ultrasound shows the fibroid with heterogeneous internal echoes and no internal vascularity on colour Doppler. Which type of fibroid degeneration is most likely, and what is its characteristic MRI signal behaviour?

• A Calcific degeneration, signal void on all sequences
• B Hyaline degeneration, T2 markedly hyperintense
• C Myxoid degeneration, T1 hyperintense with fat saturation
• D Red degeneration, T1 hyperintense due to methaemoglobin ✓

Explanation

Red (carminous) degeneration results from haemorrhagic infarction of a leiomyoma, classically during pregnancy, and presents with acute pain and localised tenderness. On MRI it shows high signal on T1 weighted images from intracellular methaemoglobin, often with a variable T2 signal and sometimes a peripheral low signal rim. Hyaline degeneration is the commonest form but is typically asymptomatic, myxoid degeneration shows high T2 signal, and calcific change produces signal void foci rather than diffuse T1 hyperintensity.

Reference: Rumack's Diagnostic Ultrasound, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.