Interactive Transcript
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This is a 21-year-old patient
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who came in with menorrhagia.
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She was on LMP day three.
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So as we scroll through here, some things
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that may catch your eye, you have some
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free fluid in the cul-de-sac, maybe a few
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internal echoes in a septation, so this may
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represent a little bit of hemorrhagic material.
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And then we're going to
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concentrate on the endometrium.
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It's a bit indistinct.
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It certainly looks thickened,
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maybe there's some cystic spaces.
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So trying to figure out what this could
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possibly be in someone who is 21 years old,
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you can think about hyperplasia or atypical
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polyps, you can think about malignancy,
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all of those things a bit less common in
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a 21-year-old, though certainly possible.
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Adenomyosis, given the indistinct borders,
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can happen in 20-year-olds, but again, uncommon.
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So let's go to our color Doppler, see if that
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can help us to figure out what's going on.
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See if we can see a feeding vessel or anything
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going to that endometrium to help us figure out.
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And you can see the cervical canal down
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here, and then we're back off to one side.
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So hard to tell if there's really any blood
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flow into this kind of area right here,
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more than just, you know, a little dot here or
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there, a little bit of blood flow there.
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Maybe that is a feeding
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vessel; hard to tell for sure.
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One thing to keep in mind though,
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more that ultrasound is real-time imaging.
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It's not like CT or MRI where
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you're getting a snapshot in time.
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So you can always do this, which is
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where instead of sweeping through,
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which is what we generally do first in
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cine clips, is just instead stay still.
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So the sonographer took this picture and
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just tried to stay still in the uterus.
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You can see a little bit of bowel motion
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because you can't stop the bowel, to be honest.
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But as you concentrate here on the
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endometrium, you can see that this is moving.
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The uterus itself is not moving,
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but all of this is sort of flowing.
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And so if you remember,
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she was day three of her LMP.
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So this is just active
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blood product in her canal.
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It's mobile because it's not a mass lesion.
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It's not attached to anything.
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And so we were able to, instead of calling this
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an abnormally thickened and maybe some colored
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up or flow cystic change, could this be a polyp,
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could this be a malignancy, we were able just
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to say, this is blood product in the canal.
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She probably needs a follow-up after,
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a little bit later after her period so that
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we can figure out what is actually going on
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with her menorrhagia, but in this case,
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just blood at this point and nothing else
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to do except for a short interval follow-up
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to figure out what's going on when we
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can better image the actual endometrium.
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