Interactive Transcript
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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.
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