LAUSR

The appearance of multiple vascular channels connecting the uterus to an adjacent pelvic mass, as seen on imaging studies, is known as the ‘‘bridging vessel’’ or ‘‘bridging vascular’’ sign (Fig. 1). This is similar to the Howrah bridge which connects the cities of Howrah and Kolkata in India (Fig. 2). The ‘‘bridging vessel’’ sign was originally described on ultrasound with use of color Doppler imaging, but it may also be appreciated on CT or MR imaging [1, 2]. The sign helps in differentiating a mass of uterine origin, typically a subserosal fibroid, from other pelvic masses [2]. The demonstration of the feeding (bridging) vessels is best seen when the subserosal fibroid is larger than 3 cm in diameter [3]. The feeding arteries located at the interface between uterus and exophytic uterine mass may be either intervening vessels (vessels running parallel to the interface), crossing vessels (vessels running across the interface), or a mixture of types depending on their course [1, 3]. The sensitivity and specificity of ‘bridging vessel sign’ in identifying subserosal fibroids range from 90% to almost 100% [2, 4]. It should be noted that ovarian masses invading the uterus may rarely produce a falsely positive bridging vessel sign [4]. Fig. 1. Transverse section of the pelvis on color Doppler imaging shows bridging vessel sign (intervening and crossing vessels marked by arrows) between the uterus (arrowhead) and the subserosal fibroid on the left side (curved arrow).