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Our next case is of a 69-year-old

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patient who presented to the ED

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with abnormal vaginal bleeding.

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Just going to show you our

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sagittal uterus imaging right here.

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And so we have a couple incidental findings.

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She definitely has fluid in the endometrial

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canal and maybe some nodularity right here.

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Could that be a polyp?

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Could that be a little bit of blood products?

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We have lots of echogenic foci

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out in the periphery.

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These may be calcified vessels given her age.

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And then we have this focal mass-like,

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very echogenic structure back here in the myometrium.

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And so when you're thinking on

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ultrasound, what's your differential

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for very bright structures?

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We have calcium, which this is not.

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If this is this heavily calcified and

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this large, it should be shadowing.

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And this is clearly not shadowing.

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You can think about air.

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However, similar type of thing.

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If you have this much large kind of globule of

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air, you would see dirty shadowing behind it.

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You wouldn't see the

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structures behind it nicely.

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So this isn't air.

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Other things that are bright on ultrasound,

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of course, are going to be fat.

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So this is probably fat in

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the uterus or a lipoleiomyoma.

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So this is fatty degeneration of a fibroid.

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So here's your color Doppler imaging.

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We're not seeing too much color Doppler flow

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in there, nor do we actually see color Doppler

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flow in the structure within the endometrium.

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So it might just be a little

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bit of blood products in there.

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Patient also had a CT scan.

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I like to look at the uterus

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on your sagittal images.

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And again, this is not

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the greatest for contrast

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purposes, but it's good enough to diagnose.

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So here you can see right here, we have this

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hypodense structure in the anterior uterus

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and put a Hounsfield unit on it, negative

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nine, which is going to be very similar to

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the mesenteric fat or subcutaneous fat that

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confirms if you weren't 100% sure.

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We now know this is a fatty lesion.

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This is a lipoleiomyoma.

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56 00:01:57,635 --> 00:01:57,955 Alright.

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One last thing to consider here

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too, because this is a nice example.

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We talked earlier in this about retroversion,

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anteversion, and that kind of stuff.

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So this is a retroverted

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uterus, and it is retroflexed.

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And that means that this is still going

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to be the anterior part of the uterus.

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This is not posterior, and it proves

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that too in the CT right here.

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It's in the anterior uterus, not the

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posterior wall of the uterine structure.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Women's Health

Uterus

Ultrasound

Gynecologic (Gyn)

Gynecologic (GYN)

Genitourinary (GU)

Body

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