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Multiple Imaging Findings of Adenomyosis

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Okay, and case four that we have here is a

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kind of bring it all together case where it

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has lots of different findings in adenomyosis.

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So this is one of those entities where

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you can have, you know, one of the

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findings, you can have two of the findings,

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or you can have all of the findings.

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So this is one where it has a

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lot of different findings here.

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So we're going to just start

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with some still images here.

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The uterus itself, a little bit globular here,

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with a fundus.

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And already endometrium, really hard to say what

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it is, is just this very thin stripe right here.

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Is it this whole larger structure right here?

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And then you see these echogenic nodules already

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emanating and a poor interface right there.

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So already we're thinking

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this person has adenomyosis.

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Keep scanning through a bit.

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Again, now you have a

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myometrial cyst right here.

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It almost looks like endometrium

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is really extending out here.

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It's really hard to tell exactly where the

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endometrium ends again, where it should

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be versus where it is in the myometrium.

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Now we have some color Doppler flow.

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We have, again, this penetrating

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appearance of the vessels as opposed to

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a fibroid right here and more echogenic

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emanating striations heading out.

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We have our nodules here again as well.

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So we have a little bit of everything

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on this particular patient.

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We go through our cine clips

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just again to show you those

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striations of echogenic nodules.

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little cysts, the poor interface.

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She's got all of the findings pretty much of

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adenomyosis minus the Venetian blind sign.

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That's pretty much the only one we

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don't have in her particular case.

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One more image here of the endometrial

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stripe in a slightly different view.

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She actually ended up having a little bit

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of everything, not just adenomyosis, but she

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did have a well-defined fibroid right here.

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And again, the difference here between this

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case and some of the other cases, you can see

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exactly where that fibroid stops and where

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the regular myometrium begins right here.

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So it probably has a

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submucosal component as well.

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It has a very different appearance than

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the adenomyosis that we've seen otherwise.

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Other things you might notice as you're

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scrolling through this case on your

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own is that there's a focal echogenic

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structure within the endometrium.

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So she actually ended up having a polyp as well.

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So she really did have a little bit

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of everything in this particular case.

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So if we go back to the still images

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and look at the 3D, remembering this

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is a retroverted retroflexed uterus, so

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everything's going to be flipped upside down.

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You can see beautifully her

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endometrium right here, right?

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We see a little divot right here and right here.

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One of those is probably going to be

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from that fibroid we saw right there.

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And you can also look for those

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little emanations coming out.

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If you look really closely, again,

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I wouldn't use this to decide it.

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I think it's better seen on the grayscale,

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but you can see some little striations

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that are coming out in different locations.

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Again, that's the endometrium

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extending out into the myometrium.

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Here we zoom in a little bit more.

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I think you can see them a little bit better.

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There's kind of nodules right

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here and just kind of confirms it.

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Fibroid right here with a submucosal

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component, more striations

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and nodules over here as well.

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So you can see it on 3D

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if you're looking for it.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Vascular

Uterus

Ultrasound

Idiopathic

Gynecologic (GYN)

Body

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