0:01

Our next case, we have an MRI of a 44-year-old female.

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She had dysfunctional uterine bleeding,

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and she had an outside ultrasound performed

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of her pelvis that was read as abnormal.

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We thought she had a fibroid and

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a left adnexal mass/cyst.

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Weren't really sure what was going on there.

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So she comes here for MRI.

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So let's start with our T2.

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I'm gonna make that a little bit bigger for you.

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And there's already a lot going on here.

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Before I start talking too much,

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just kind of scroll through this again.

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So if we're going to focus just on the

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uterus and adenomyosis, because we're

0:36

still in the adenomyosis lesson, you can

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already tell this uterus is large.

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It's globular.

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We have this ill-defined structure

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in the posterior, asymmetrically

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affecting the posterior uterus here.

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No well-defined borders, and all

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these T2 bright foci, right?

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We have adenomyosis. Got that one.

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But we have a whole lot else that is

0:55

happening in this particular patient.

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We have these T2 bright cystic structures.

1:00

We have more of them over

1:01

here in the left adnexa.

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Here, I would argue that this

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is sort of serpiginous, right?

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This is not necessarily an ovary.

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This looks like a dilated

1:08

fluid-filled fallopian tube.

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And then this structure back here with

1:12

maybe some T2 shading in it, perhaps.

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So I wonder if we have

1:16

some sort of hydrosalpinx.

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Maybe an abnormal cystic structure in

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the left ovary as well that we'll need

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to look at some other sequences for.

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And then one other thing to look at

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right here is look at the rectum.

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So you have your perirectal fat right here.

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Uterus should be right here.

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This is an intraperitoneal structure.

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This should be a posterior peritoneal structure.

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They should be separate.

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As we scroll up, it almost looks like

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everything is like pinched towards this.

1:40

This is almost like pinching

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down to this point right here.

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So this is an adhesive process right here.

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And then as the rectum comes up right

1:47

through here, so this is suggesting

1:49

that there are adhesions back here.

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So putting together adenomyosis, which is

1:54

ectopic endometrial tissue, we have a dilated

1:58

fallopian tube and this abnormal structure.

2:00

Let's see if we can figure out what that structure

2:02

is by going to our pre-contrast T1s.

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And in this case, that fallopian

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tube is completely bright.

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So this is blood, right?

2:09

This is a hematosalpinx, not just a hydrosalpinx.

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Getting down to that ovarian structure,

2:14

what we thought was ovarian T1 bright, right?

2:17

So that is an endometrioma.

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So this, you know, quote-unquote

2:20

cystic mass in the left adnexa is a

2:22

blood-filled tube and an endometrioma.

2:26

And again, a few foci of T1 bright

2:29

signal within that adenomyosis

2:31

there, which again is expected.

2:34

I like the T2 sagittal here again to

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kind of go back and confirm that what

2:38

I thought was going on here really is.

2:41

There really is some sort of adhesive-like

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scarring process right here where everything's

2:46

sort of starting to tether together right here.

2:49

And so what this is, if you put it

2:50

all together, it's not one distinct

2:53

entity or two distinct entities here.

2:55

Adenomyosis is absolutely

2:57

associated with endometriosis.

2:59

So she has endometriosis

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and then adenomyosis as well.

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So you can have adenomyosis on its

3:06

own, but there is that relation.

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So it's important to look and you can

3:09

see how everything's tethering here

3:10

on this coronal view. It ended up being one of

3:13

the more important views right here.

3:14

Everything's tethering together right here.

3:18

And so this is adenomyosis and

3:20

endometriosis together right here.

3:22

She did end up going to surgery for

3:24

this, which showed all of those findings:

3:26

adenomyosis and then endometriosis in the

3:29

left ovary and throughout the fallopian tube.

3:31

And then she did have

3:32

multiple adhesions as well.