Assessment of the Clinical Presentations and Ultrasonographic Features of Uterine Fibroids in Adult Africans: A Retrospective Study

Abstract

Objectives: We sought to determine the clinical presentations and ultrasonographic features of uterine fibroids in adult Ghanaians.

Methods: Between 1 January 2018 and 31 December 2021, 4279 ultrasound-confirmed cases of uterine fibroids were retrieved. The data obtained, which included age, clinical presentations, and sonographic features were analyzed. A chi-squared test was done to assess for possible associations between the clinical indications, age distribution, and ultrasonographic features of uterine fibroids.

Results: The mean age of the patients diagnosed with uterine fibroids was 37.1±11.5 years (range = 16-69 years). Routine checkup (n = 1310, 28.1%), menorrhagia (n = 1104, 23.7%), and lower abdominal mass (n = 801, 17.2%) were the leading clinical indications. Dysmenorrhea, amenorrhea, menorrhagia, and routine checkup were significantly noted in the younger patients (p ≤ 0.001). The majority of the fibroid nodules had smooth regular outline (n = 4125, 96.4%) and were mostly heterogeneous (n = 3282, 76.7%). The echo pattern of the nodules was predominantly hypoechoic (n = 3358, 51.1%) followed by hyperechoic nodules (n = 2554, 38.9%). Degenerative changes accounted for less than one-third of the total fibroid nodules, with the least recorded degenerative change being nodules with cystic areas (n = 55, 5.4%) and the most observed degenerative feature being nodules with rim of calcification and areas of calcified degeneration (n = 965, 94.6%). Almost all the sonographic features were significantly seen in the 30-44 years age category.

Conclusions: Sonographically, uterine fibroids were mostly hypoechoic heterogeneous nodules with a smooth regular outline with a predominant occurrence within women in the fourth to fifth decade of life.

Keywords: Ghana; Leiomyoma; Ultrasonography.

Figure 1

Indications for patients diagnosed with fibroids.

Figure 2

Transabdominal sonograms of the uterus showing a heterogeneous but predominantly hypoechoic fibroid nodule with a smooth regular outline at the anterior part (red arrows).

Figure 3

Transabdominal sonograms of the uterus showing a heterogeneous but predominantly hyperechoic fibroid nodule at the posterior part (red arrows).

Figure 4

Transabdominal sonogram of the uterus showing a heterogeneous fibroid nodule with a rim of calcific degeneration (red arrows).

Figure 5

Transabdominal sonogram of the uterus showing an isoechoic fibroid nodule (orange arrows) with areas of cystic degeneration (red arrows).

Figure 6

Distribution of uterine fibroids in various age groups.