Interactive Transcript
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The first case is of a 57-year-old female who's
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postmenopausal for approximately five years.
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We'll start here with her
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sagittal uterus cine clip.
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I find in the diagnosis of adenomyosis,
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the sagittal is just indispensable.
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This is what I use to diagnose it.
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So just scrolling through
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once, the uterus is slightly small.
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Again, she's postmenopausal five,
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five years, so that makes sense.
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We'll stop sort of centrally here.
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Where exactly would you
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measure this endometrium?
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Now here, maybe you have a nice good
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interface right here where the endometrium
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ends, the myometrium starts, but in other
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places it's really hard to tell if it's at
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the end here, maybe over here, way up here.
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And that's because we've lost that interface.
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The other things that we're seeing here, we're
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seeing these echogenic like striations like
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emanating out from the endometrium down here.
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We're also seeing these nodules right here,
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right here, these echogenic nodules, more
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nodules right here, and these are not in the
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endometrium, they're in the myometrium adjacent.
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More nodules here, striations here,
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striations here, so in this case, you can
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actually maybe see the junctional zone.
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I said, you don't often see it with ultrasound,
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but I can certainly imagine this is probably
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a thickened junctional zone right here.
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And again, these striations and echogenic nodules,
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which are the same sort of
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echogenicity of the endometrium itself.
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Those are the ectopic endometrial glands
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emanating out into the myometrium right there.
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And in this case, our sonographer was
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practicing with the 3D right here.
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It's not the most beautiful image right here.
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We have, you know, vague fundal contour
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right here, endometrium right here,
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and you can see all these little bright spots.
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One of the reasons why this didn't turn out
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really nicely is because you see all of these
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bright spots emanating out from the endometrium
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here, because that is ectopic endometrial
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tissue extending out into the myometrium.
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So this is a pretty classic example of
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adenomyosis, where you get the loss of
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the interface between the endometrium and
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myometrium, and you see these emanating
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striations and echogenic nodules into the
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myometrium from the endometrium there.
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This is classic adenomyosis.
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