PMC7128062_01
(a) Contrast-enhanced CT image with large volume hemoperitoneum (FF) and an enlarged uterus secondary to a large enhancing fibroid (UT). Sentinel blood clot in the pelvis with same enhancement as bowel loops nearby (arrow). (b) Noncontrast CT image of the retracted sentinel blood clot measuring 60 Hounsfield units (arrow). (c) Surgical specimen of the cervix and the uterus with a ruptured mass on the posterior aspect. (d) Highly cellular leiomyoma with blood (BL) tracking to the serosal surface (SS) and hemosiderin-laden macrophages (inset). Hematoxylin and eosin stain at high power magnification.
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Findings included moderate to large volume dense-free fluid (30 Hounsfield units) throughout the abdomen in keeping with large volume hemoperitoneum (Figure 1(a)). Noncontrast images showed a retracted sentinel clot in the pelvis measuring 60 Hounsfield units consistent with clotted blood, which was not distinguishable from normal enhancing myometrium and bowel wall on the contrast-enhanced images given the similar attenuation of enhanced muscle and clotted blood (Figure 1(b)). Within the myometrium and fibroid, there was a heterogeneous hyperdense attenuation with serpiginous hyperdense areas suggestive of clot and acute rupture (Figure 1(b)). An approximately 9 cm mass at the posterior aspect of the uterus was ruptured and actively bleeding (Figure 1(c)). There was also evidence of previous subclinical bleeding with intratumoral hemosiderin-laden macrophages (Figure 1(d)).