0:01

This pelvic ultrasound is of a 42-year-old who came

0:03

in with an LMP of two days prior to her imaging.

0:08

She came in for intermenstrual bleeding.

0:10

As we scroll through this sagittal cine clip,

0:12

we have a lot of different findings here.

0:14

We have some venetian blind sign; again,

0:17

ignoring the ones coming from the vessels. q 8 00:00:19,160 --> 00:00:22,250 We have some venetian blind sign over

0:22

here that suggests some adenomyosis,

0:25

and there are ill-defined borders

0:27

of the endometrium and myometrium,

0:29

particularly back here.

0:30

So we definitely have some adenomyosis, but we

0:32

have this structure in the endometrium, and we

0:35

see a lot of shadowing here, not just a venetian

0:38

blind — you know, dark, bright, dark, bright —

0:40

but you know, lots of dark here, a little bit

0:41

of bright, little bit of dark, more bright here.

0:44

This is not a venetian blind.

0:46

You also can see that there's some, you know,

0:48

sort of echogenic areas that are coming from.

0:50

So this might be a partially calcified

0:52

mass that's in the endometrium right here.

0:56

Look at our color Doppler imaging; see if

0:57

that gives us a little bit more information.

1:04

And here's your venetian blind

1:05

type of appearance of adenomyosis.

1:08

And if you see some penetrating

1:09

vessels in the color Doppler flow,

1:11

then as we get towards the endometrium,

1:15

we see a bit more flow to this structure.

1:18

Sort of disorganized flow in that general area.

1:23

And so then we were able to suggest, given

1:25

the calcifications, this sort of irregular

1:28

flow going to it, that this was most likely

1:30

going to be a partially calcified fibroid.

1:33

Your differential is still going

1:34

to be an endometrial malignancy.

1:35

She was 42, so she's a little bit young

1:38

to have that, but certainly possible.

1:39

Either way, though, you need the gynecologic consult to figure out what this is.

1:43

It did go in to take this out

1:45

given her abnormal bleeding history,

1:47

and it was an intracavitary fibroid.

1:49

So always something to think about, especially

1:51

if it looks a little, a little bit atypical

1:53

from what we've been seeing — you know, a lot of

1:54

calcification, a lot of weird blood flow to it.

1:58

That's another thing to think

1:59

about is an intracavitary fibroid.