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Venetian Blind Appearance of Adenomyosis

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Our next case is of a 45-year-old patient

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with heavy bleeding times three years.

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She is a premenopausal at this point.

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So again, let's just start with

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our sagittal imaging right here.

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And as we scan through here, we can see some

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asymmetric myometrial thickening, right?

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The anterior myometrium is much thinner

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than the myometrium posteriorly.

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And this is a sagittal image.

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So you can't really otherwise explain why

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this is so much thicker than anterior here.

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Also, as we scroll through here, now

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you're going to see that Venetian blind.

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You can see that alternating shadow

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and increased echogenicity right here.

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In this case, it's not tracking back

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to the arcuate arteries, either very

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anterior or posterior right here.

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It's tracking to this process right here.

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So this is asymmetric myometrial thickening.

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We have Venetian blind sign here.

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And then we can look to see if we

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find any other signs as well, such as,

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you know, very small cystic spaces.

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As we can see some of them within this

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structure, like the little one right there.

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Little one right here, little one right there.

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So these are not, you know, along the

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interface of the myometrium and endometrium.

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These are in this structure.

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So you might say, could this just be a fibroid?

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Fibroids can shadow, but they don't often

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have this Venetian blind appearance.

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The other thing is that they

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should have a well-defined border.

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You should be able to measure where

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this starts and where this ends.

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And I would argue here, it just kind of

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blends into the tissue next to it right there.

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I can't tell you where this

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starts and where this ends.

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It's blurred, no well-defined borders.

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So this is going to be adenomyosis right here.

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So, if you weren't entirely sure, we threw on

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some color Doppler, so in this cine clip, still

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sagittal, gives you a beautiful example of

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these penetrating tortuous vessels right here.

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Look at those, it's completely

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asymmetric where you just see, you know,

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dots of vascularity here and there.

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This is vessels.

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The arcuate arteries right here that

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are filling as they should, but you have

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this very different appearance of these

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penetrating little bit torturous vessels

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heading right into this structure right here.

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This is not circumferential

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vascularity of a fibroid.

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This is not a classic appearance for that.

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This is the penetrating vascularity

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that is classic for adenomyosis.

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So this is focal adenomyosis or

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an adenomyoma potentially of the

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posterior uterine body right here.

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Classic appearance 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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