Goldberg Fibroid Treatment Algorithm
Severe adhesions involving pedunculated fibroids following UFE:
Image 1, Image 2
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| Huge fibroid uterus: |
| Axial CT scan in a patient with a huge fibroid uterus occupying most of the abdominal cavity. |
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| Hydronephrosis from ureteral compression:
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| Right uterine arteriography showing a large fibroid compressing the left ureter causing hydronephrosis. |
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| Fibroids distorting endometrial canal:
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| Sagittal MRI (T2-weighted) showing multiple fibroids distorting the endometrial canal. |
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| Pre-hysterectomy UFE |
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A 50+ year old woman with a rapidly enlarging 32+ week sized fibroid uterus requested a hysterectomy for symptom relief and
to rule out uterine leiomyosarcoma. UFE was performed several weeks prior to decrease her surgical risk by shrinking the mass
and devascularizing it. Due to the massive fibroids distorting her uterine anatomy, the fibroids had to be nearly entirely
cored out of their serosal covering to recreate normal anatomy. As a result of the prophyllactic UFE, the fibroids were degenerating,
fluid filled, and almost completely avascular. This reduced blood loss considerably. The patient did well, without post-op
complication. She was discharged on post-op day 2. Pathology reported only benign leiomyoma (fibroid).
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Total Abdominal Hysterectomy Performed after UFE
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| Pre- and post-UFE MRIs |
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Sagittal gadolinium enhanced MRI of the pelvis demonstrates a large (6cm) enhancing (vascular) fibroid (arrow) and an enlarged
uterus (13 cm x 8cm x 9cm).
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Figure 2
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Sagittal gadolinium enhanced MRI of the pelvis 3 months following uterine artery embolization demonstrates a smaller (4cm)
nonenhancing (avascular) fibroid (arrow) and a uterus which has decreased in size (10cm x 5cm x 6cm).
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| Myomecty preceeded by Embolization |
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Image
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CT scan of 40 week fibroid uterus prior to uterine fibroid embolization |
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Uterine fibroid embolization with angiography demonstrated extremely tortuous and ovaian artery supplying a 40 week size fibroid
uterus
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11 fibroids removed from 40 week sized uterus preceded by UFE |
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40 week sized uterus was shrunk to 35 week size by UFE prior to undergoing myomectomy. Note the marked devascularized areas |
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40-sized uterus after UFE followed by myomectomy 4 weeks later |
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Partially devascularized pedunculated fibroid 4 weeks following UFE |
Images are courtesty of BioSphere Medical, Inc.
Fibroids are classified based upon their location within the uterus.
Another view of fibroid types which includes the surrounding vasculature.
The catheter is inserted into the uterine artery via a small nick in the patient's upper thigh.
Embosphere Microspheres are injected through the catheter into the fibrod vasculature.
After the fibroids are embolized, they shrink and die.
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Jacques Ravina, MD, of Paris, France, who first reported uterine fibroid embolization as a primary treatment for uterine
fibroids, and Jay Goldberg, MD, Director of the Jefferson Fibroid Center. Photo taken at the 2003 FIGO World Congress in Santiago,
Chile, where they presented a symposium on uterine fibroids.
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