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Polyps

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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.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

Ultrasound

Neoplastic

Idiopathic

Gynecologic (GYN)

Body

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