Your 45-year-old female patient complains of irregular menstrual cycles, severe pain with menses and heavy bleeding every month for the last year. On examination, you palpate an enlarged uterus. Pregnancy test is negative
A recommended diagnostic test for this patient is:
A. Abdominal CT scan
B. Kidney, ureter, bladder x-ray
C. Pelvic ultrasound
D. Abdominal MRI
ANS: C
Uterine leiomyomas, more commonly known as uterine fibroids, are benign growths consisting mostly of smooth muscle. The etiology is unknown, but their growth is hormone dependent; therefore, they are seen in approximately 25% of women during their reproductive years. Heavy menstrual bleeding (menorrhagia) and irregular bleeding (metrorrhagia) are the most common presenting symptoms, although a large percentage of patients are asymptomatic. Other symptoms include heaviness or fullness in the lower abdomen, pelvic pain, backache, dysmenorrhea, and urinary complaints. Most leiomyomas can be palpated on bimanual examination, and some larger fibroids can be palpated through the abdomen. The uterus may feel enlarged, irregular, or nodular. A pregnancy test should be performed to rule that out as a cause of the symptoms. A CBC is needed in cases of heavy bleeding to determine whether anemia or platelet disorder is present. Pelvic ultrasound or MRI should be performed if symptoms of leiomyoma are present or for any palpable pelvic mass detected on physical examination.
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