Diagnosis is primarily using ultrasound. Always look for the cervical canal, if u can see a full caliper cervical canal, ur dealing with a pseudocervical myoma which u should attempt to remove. I actually had a recent case where we - by the great role of prof. Ossama alashkar-managed to do myomectomy to a huge 17cm pseudocervical myoma compressing the cervix anteriorely. Mother and fetus in perfect shape
If there is a huge myomas then clinically difficult to differentiate in between the cervical and broad ligament fibroid.but yes ultrasound can give a clue as sir Louay says.in my practice i have operated huge myomas ofsize 34 weeks size of uterus also.but on table i must say sometimes we get surprises for the surgeon.
I agree, and MRI can differentiate as well. The surgical problem is similar for both-- avoiding ureteral injury and avoiding uterine artery injury that (1) predisposes to ureteral injury; and (2) may result on transfusion and even hysterectomy. So, open the sidewall, identify the ureter early if possible, shell the fibroid out going from lateral to medial, and trace the ureter through the pelvis when resection and reconstruction are complete. Consider laparotomy with the patient in stirrups and a sound in the cervis. If yo do not do ureteral dissection frequently, consider a stent.
Diffusion weighted contrast enhanced MRI might be helpful here as the ADC value of the broad ligament is different to that of the cervix and there for the fibroid position can potentially be diagnosed that way. Uterine artery embolisation won't have a substantial effect on a broad ligament fibroid but will on a cervical fibroid.
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