A 28-year-old woman at 14 weeks of pregnancy presents with acute left flank pain and localised uterine tenderness over a known 6 cm intramural fibroid. Ultrasound shows the fibroid with a peripheral hypoechoic rim and surrounding echogenic halo, with loss of internal vascularity in part of the lesion. What is the most likely diagnosis?
- A Torsion of a subserosal fibroid pedicle
- B Red degeneration of the leiomyoma ✓
- C Leiomyosarcomatous change
- D Placental abruption overlying the fibroid
Correct answer: B. Red degeneration of the leiomyoma
Explanation
Red or carneous degeneration is aseptic infarction of a leiomyoma, common in pregnancy when rapid growth outruns blood supply, presenting with acute pain, fever and leucocytosis. Sonographically the fibroid shows altered echo texture with a hypoechoic or echogenic rim and areas of lost vascularity, and it is managed conservatively with analgesia. Leiomyosarcoma is a postmenopausal concern unrelated to acute pregnancy pain, and abruption would show retroplacental clot, not a fibroid rim.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.