Interactive Transcript
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Our next case is of a 24-year-old
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patient who got her pelvic ultrasound
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as part of an infertility workup.
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At the time of this ultrasound, her LMP was
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approximately three and a half weeks earlier,
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which would put her in the secretory phase.
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So when you're thinking about
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what a normal thickness should be,
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we're in the secretory phase here.
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So maybe up to 18 mm or so tops.
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So this is not the prettiest set of
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images, but it's certainly diagnostic.
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And you can see here that this
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endometrium is very thick.
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You can see a nice rim of myometrium around it,
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but no matter how you slice it, this is
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going to be far too thick at 22 mm.
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So this is abnormally thickened,
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but it's homogeneously thickened.
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At this point, I don't see a
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focal echogenic lesion, although
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one certainly could be obscured.
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but just rather complete diffuse thickening.
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Go to the color Doppler images just
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to complete your workup and make sure
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we don't see any abnormal vascularity.
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And again, you almost see the
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endometrium a little bit better here.
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What's interesting is you do see this single
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feeding vessel crossing from the myometrium
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here into the endometrium right here.
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And then maybe if you squint a little
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bit, maybe there is something a little
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bit brighter right here as well.
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Again, the background is thickened straight.
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That's thickened no matter what, but we
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may have a little polyp here as well.
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I'll go backwards a little bit.
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Feeding vessel to this echogenic structure.
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So we have an abnormally diffusely thickened
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endometrium here and probably an underlying polyp.
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43 00:01:28,744 --> 00:01:31,255 Unfortunately, this ended up being
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read at the time, as probably due to her
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late-phase encyclical, could repeat it
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after an LMP if indicated,
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and she hasn't yet had repeat imaging
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to prove what's going on here.
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So putting this all together, this is
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an abnormally thickened, homogeneously thickened
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endometrial stripe and probably
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represents endometrial hyperplasia.
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She probably also has a polyp here on
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the background of this hyperplasia.
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Either way, though, she does need to
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have a biopsy, and that's what you should
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recommend if you see a case like this.
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