0:01

So our next case is a 20-year-old who's six

0:04

months postpartum. Looking at our sagittal uterus

0:07

picture, wWe can already see some heterogeneity.

0:11

As we scroll through it, you almost wonder if

0:15

there's a venetian blind effect, and that's where this

0:17

alternating, like, bright and dark.

0:19

Here, like a Venetian blind, could cause shadows.

0:22

That's what a Venetian blind sign is.

0:24

However, you have to note

0:25

where they're coming from.

0:26

If they are tracking back to the uterine

0:28

arcuate arteries, which will be in the periphery

0:30

right here, that's not a Venetian blind.

0:32

That's just an artifact

0:33

because of the vessels there.

0:35

You know, you can have increased through

0:37

transmission because of the endometrium

0:39

itself, tThat's not necessarily it.

0:41

So you have to be aware of where

0:42

those Venetian blinds are coming from.

0:44

And that's not just, you know, physiologic

0:46

coming from the arcuate arteries.

0:47

It would have to come from the

0:48

myometrium itself to suggest adenomyosis.

0:51

But, as we're going through here,

0:52

we do have a submyometrial cyst

0:54

right here below the endometrium.

0:55

It is not in the endometrium itself.

1:01

And so small cysts at the endometrium,

1:04

myometrium junction, those are going to be the

1:06

most sensitive and specific for adenomyosis.

1:08

So if you see those, they should range

1:11

from about 1-5 millimeters in size,

1:12

which this one definitely would fit.

1:15

I'd like to see more than one, but

1:17

if you have other signs, you don't

1:18

necessarily need to see more than one.

1:21

In this particular case, it felt like

1:22

you could probably see some little

1:24

echogenic nodules right here as well.

1:27

So the difference here is these

1:28

are ectopic endometrial

1:31

tissue, but so is this.

1:32

But in this particular case, it probably bled

1:34

at some point and now is just fluid-filled.

1:36

So it's just a different appearance of

1:38

these ectopic endometrial glands right here.

1:40

So in this particular case, we have the cysts.

1:42

We have some echogenic nodules.

1:44

The uterus itself is a bit globular.

1:46

It's really quite a large uterus right here.

1:49

So this is a case that is probably adenomyosis.

1:52

She's very young, but again,

1:54

you can get adenomyosis in your 20s.

1:56

So this is one where I would suggest

1:58

it's adenomyosis because it certainly

2:00

looks like it's heading that way,

2:01

if it's not adenomyosis already at this point.