Red degeneration of uterine leiomyoma is a subtype of uterine fibrinoid degeneration, including hyaline, cystic, myxoid, and red (1). It can present as an acute abdominal pain with low-grade fever, occurring in 8% of tumors complicating pregnancy and 3% of all uterine leiomyomas (2,3). The name is derived from its beefy red color due to the coagulative necrosis indicating the presence of abundant thrombosed vessels at the periphery of the lesion caused by simultaneous and abrupt shutting off of the drainage veins (4). Although CT findings are often heterogeneous, and magnetic resonance imaging is the gold standard in evaluating uterine degeneration, contrast-enhanced CT imaging can rule out urgent conditions related to fibroids, including torsion, prolapse of a submucous fibroid, ureteric obstruction, venous thromboembolism, or intestinal obstruction (1,5). Our patient was treated with hysterectomy and bilateral salpingo-oophorectomy, in which the diagnosis was confirmed by the typical pathological feature of intramural fibroid (Figure 2).