case_images: PMC10244948_01
case_images: Grey-scale and Doppler ultrasound. Transverse (a) and sagittal (b) grey scale transabdominal ultrasound images of the abdomen and pelvis depict a large, well-circumscribed, heterogeneous, solid abdomino-pelvic mass (arrow), abutting the uterine fundus (double arrow in b) with no internal colour flow on Doppler evaluation (c). Transvaginal sagittal Doppler ultrasound image (d) demonstrates the vascular pedicle (curved arrow) between the uterus (arrowhead) and the mass, suggesting its uterine origin. Both ovaries were normal ( ) and visualised separate from the mass with a small amount of anechoic free fluid in pelvis (dashed arrow) on transvaginal transverse (e) and sagittal grey scale images (f).
case_images: SAJR-27-2641-g001.jpg
case_images: PMC10244948_01_SAJR-27-2641-g001.jpg
case_images: F0001
case_images: A small amount of anechoic free fluid was seen in the pelvis (Figure 1).
case_images: MR imaging in torsion of a subserosal uterine leiomyoma. MR images depict a large solid abdomino-pelvic mass lesion (arrow in a, b) continuous with the uterus (arrowhead in b) in the region of the left cornua (double arrow in c). The mass appears hypointense on the axial T1-weighted image (a) and heterogeneous on sagittal (b) and axial (c) T2-weighted MR images compared to the uterine myometrium. The majority of the mass appears heterogeneously hyperintense on the T2-weighted image (curved arrow in c) with a thin enhancing rim and non-enhancing core on post-contrast axial (d, e) and sagittal (f) MR images (curved arrow). A small juxtauterine area of relatively homogeneous T2 isointense signal (  in c) and post-contrast enhancement (  in d-f) is seen adjacent to its site of uterine attachment. The mass showed no diffusion restriction on diffusion weighted imaging (g) and the corresponding apparent diffusion coefficient map (h).
case_images: SAJR-27-2641-g002.jpg
case_images: PMC10244948_01_SAJR-27-2641-g002.jpg
case_images: F0002
case_images: A small amount of free fluid was seen in pelvis and both ovaries were unremarkable (Figure 2).
case_images: Gross specimen and cut section of the excised twisted subserosal leiomyoma. Intraoperatively, the mass was found to be a large subserosal uterine fibroid with a twisted vascular pedicle (arrow in a). Cut section of the gross specimen (b) revealed haemorrhagic necrosis in the majority of the mass (dashed arrows) which showed lack of contrast enhancement (dashed arrow) on the post-contrast MR image (c) with viable tissue at the site of uterine attachment which corresponded to the enhancement seen on the MR image (arrowhead in b, c). Figure (c) shows the uterine attachment site of the fibroid (pedicle indicated by a curved arrow).
case_images: SAJR-27-2641-g003.jpg
case_images: PMC10244948_01_SAJR-27-2641-g003.jpg
case_images: F0003
case_images: On histopathology, the majority of the mass demonstrated necrosis with areas of internal haemorrhage, which corresponded to the non-enhancing component on MRI (Figure 3).