0:01

This is a 21-year-old patient

0:02

who came in with menorrhagia.

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She was on LMP day three.

0:07

So as we scroll through here, some things

0:09

that may catch your eye, you have some

0:11

free fluid in the cul-de-sac, maybe a few

0:12

internal echoes in a septation, so this may

0:14

represent a little bit of hemorrhagic material.

0:18

And then we're going to

0:19

concentrate on the endometrium.

0:21

It's a bit indistinct.

0:23

It certainly looks thickened,

0:24

maybe there's some cystic spaces.

0:27

So trying to figure out what this could

0:28

possibly be in someone who is 21 years old,

0:31

you can think about hyperplasia or atypical

0:33

polyps, you can think about malignancy,

0:35

all of those things a bit less common in

0:37

a 21-year-old, though certainly possible.

0:39

Adenomyosis, given the indistinct borders,

0:42

can happen in 20-year-olds, but again, uncommon.

0:45

So let's go to our color Doppler, see if that

0:47

can help us to figure out what's going on.

0:53

See if we can see a feeding vessel or anything

0:55

going to that endometrium to help us figure out.

0:58

And you can see the cervical canal down

1:00

here, and then we're back off to one side.

1:03

So hard to tell if there's really any blood

1:05

flow into this kind of area right here,

1:08

more than just, you know, a little dot here or

1:09

there, a little bit of blood flow there.

1:12

Maybe that is a feeding

1:13

vessel; hard to tell for sure.

1:16

One thing to keep in mind though,

1:17

more that ultrasound is real-time imaging.

1:20

It's not like CT or MRI where

1:21

you're getting a snapshot in time.

1:24

So you can always do this, which is

1:26

where instead of sweeping through,

1:27

which is what we generally do first in

1:28

cine clips, is just instead stay still.

1:31

So the sonographer took this picture and

1:33

just tried to stay still in the uterus.

1:35

You can see a little bit of bowel motion

1:37

because you can't stop the bowel, to be honest.

1:39

But as you concentrate here on the

1:41

endometrium, you can see that this is moving.

1:44

The uterus itself is not moving,

1:45

but all of this is sort of flowing.

1:47

And so if you remember,

1:48

she was day three of her LMP.

1:50

So this is just active

1:52

blood product in her canal.

1:53

It's mobile because it's not a mass lesion.

1:55

It's not attached to anything.

1:57

And so we were able to, instead of calling this

1:59

an abnormally thickened and maybe some colored

2:01

up or flow cystic change, could this be a polyp,

2:04

could this be a malignancy, we were able just

2:06

to say, this is blood product in the canal.

2:09

She probably needs a follow-up after,

2:12

a little bit later after her period so that

2:14

we can figure out what is actually going on

2:16

with her menorrhagia, but in this case,

2:18

just blood at this point and nothing else

2:20

to do except for a short interval follow-up

2:22

to figure out what's going on when we

2:23

can better image the actual endometrium.