Interactive Transcript
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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
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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
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happening in this particular patient.
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We have these T2 bright cystic structures.
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We have more of them over
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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
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fluid-filled fallopian tube.
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And then this structure back here with
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maybe some T2 shading in it, perhaps.
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So I wonder if we have
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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.
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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
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through here, so this is suggesting
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that there are adhesions back here.
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So putting together adenomyosis, which is
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ectopic endometrial tissue, we have a dilated
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fallopian tube and this abnormal structure.
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Let's see if we can figure out what that structure
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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?
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This is a hematosalpinx, not just a hydrosalpinx.
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Getting down to that ovarian structure,
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what we thought was ovarian T1 bright, right?
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So that is an endometrioma.
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So this, you know, quote-unquote
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cystic mass in the left adnexa is a
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blood-filled tube and an endometrioma.
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And again, a few foci of T1 bright
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signal within that adenomyosis
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there, which again is expected.
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I like the T2 sagittal here again to
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kind of go back and confirm that what
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I thought was going on here really is.
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There really is some sort of adhesive-like
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scarring process right here where everything's
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sort of starting to tether together right here.
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And so what this is, if you put it
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all together, it's not one distinct
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entity or two distinct entities here.
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Adenomyosis is absolutely
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associated with endometriosis.
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So she has endometriosis
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and then adenomyosis as well.
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So you can have adenomyosis on its
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own, but there is that relation.
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So it's important to look and you can
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see how everything's tethering here
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on this coronal view. It ended up being one of
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the more important views right here.
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Everything's tethering together right here.
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And so this is adenomyosis and
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endometriosis together right here.
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She did end up going to surgery for
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this, which showed all of those findings:
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adenomyosis and then endometriosis in the
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left ovary and throughout the fallopian tube.
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And then she did have
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multiple adhesions as well.
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