Interactive Transcript
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So now let's move to some cases as
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we review the differential diagnosis
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for abnormal endometrial thickness.
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We'll start here with this 34-year-old who's
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experiencing bleeding after intercourse.
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We're going to start here with
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a uterine sagittal sync eclipse.
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I love my uterine sagittal sync eclipse as
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you'll, you'll see throughout this talk.
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We do have a sort of trilaminar appearance
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to her endometrial stripe right here.
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As we keep going, keep going, we see a
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little bit of focal thickening right here.
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Not super echogenic, but it looks
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different than everywhere else, right?
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Keep going, and there is
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a second one right there.
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This one is a little bit more echogenic,
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kind of similar to myometrium here,
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but it's clearly within the endometrial canal
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as we continue to scroll through that.
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So those are two things I want
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to keep my eye on, two echogenic
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lesions within the endometrium.
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So with that, we'll go to the color
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doppler cine sequence here, and you
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can see lots of flow to the uterus.
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A little bit of artifact there.
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Some dirty shadowing from the rectum behind.
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And it's going to be kind of right here.
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There's our first little thickened
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structure coming in right here.
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I'm going to draw your eye before you
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even see that echogenic structure.
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You see this single feeding vessel
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going from the endometrium right
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into that structure right there.
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And that can help confirm that this is a
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polyp and not just be suggestive of a polyp.
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So as we keep going through this sequence,
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we're going to look for that second
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lesion, which is up around this area.
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You can see we're coming into it right there.
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And in this case, you can see the flow
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is coming from the anterior uterus.
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We have a feeding vessel feeding that.
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So then we can confidently say we have two
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polyps in the endometrium, as opposed to
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just saying likely polyps and correlate with
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dysfunctional uterine bleeding, et cetera.
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So a polyp is going to be usually echogenic.
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you usually will see one feeding vessel.
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If you see one vessel that is high specificity
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versus a fibroid that can occasionally
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be intracavitary, they're generally going
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to have more than one feeding vessel.
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And so just to review, a polyp is a hyperplastic
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growth of the endometrial gland and stroma.
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They may be asymptomatic or they may
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have dysfunctional uterine bleeding.
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So just because they don't have a history of
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dysfunctional uterine bleeding, if you see
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something that looks like this, it doesn't
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mean that you don't call it as confidently.
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You certainly can because they
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may still be asymptomatic.
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