ADENOMYOSIS

22 YEAR OLD FEMALE WITH POG OF 5WKS . EPISODIC PAIN IN THE

LOWER ABDOMEN.

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

DIFFERENTIATE ADENOMYOSIS

FROM LEIOMYOMA

FEATURES OF ADENOMYOSIS

• Echogenecity of mass---------- Hyperechoic• Borders of the mass------------ill -defined• Vascularity of the lesion------- Penetrating • Size of uterus---------------------Bulky with asymmetrical

lobulations ( anterior and posetrior). • Junctional zone-------------------Thick. ( >8mm ( 8-12mm)

>12mm) ( MR sagittal plane T2w sequence gives best assesment of junctional zone)

• Subendometrial / Intramyometrial cysts -Present .

FEATURES OF LEIOMYOMA

• Echogenecity of mass---------- Hypoechoic• Borders of the mass------------Defined• Vascularity of the lesion------- Peripheral • Junctional zone------------------- Normal.• Subendometrial / Intramyometrial cysts- Not present .

Present case ......................

•Bulky uterus with lobulated outline •Heterogenous pattern of the Myometrium•Intramyometrial peneterating vascularity .•Congested venous system.•Focal defined hypoechoic areas – Leiomyomas •G sac – 5wks with ? Viability----Follow up advised .

INCREASED INTRAMYOMETRIAL VASCULATURE

PENETERATING PATTERN

CONGESTED TORTUOUS VESSELS –

INTRAMYOMETRIAL . PENETERATING PATTERN

FOCAL HYPOECHOIC AREAS APPRECIATED IN THE MYOMETRIUM

WITH DEFINED BORDERS – CORROBORATIVE WITH SMALL

LEIOMYOMA.

G SAC WITH NO FETAL NODE/ NO YOLK SAC. CORROBORATES WITH POG

5WKS ODAYS ......FOLLOW UP FOR VIABILITY

HETEROGENOUS ECHOPATTERN OF

THE MYOMETRIUM

MAGNIFIED VIEW OF THE G SAC

SINGLE LINER ADENOMYOSIS CAN PREDISPOSE TO INTRAMYOMETRIAL ECTOPIC PREGNANCY

BULKY UTERUS WITH LOBULATED OUTLINE

PENETERATING PATTERN OF THE

VASCULATURE

VALSALVAE ---- Tortuos venous channels- normal response. – Pregnanacy with adenomyosis

– Associated component of pelvic congestion.

LOW RESISTANCE ARTERIAL TREE.- PREGNANT STATE

WITH ASSOCIATED ADENOMYOSIS

ECTOPIC ENDOMETRIAL GLAND WITH SMOOTH MUSCLE HYPERPLASIA

LESSON LEARNT

1. Differentiate between Adenomyosis and Leiomyoma.

2. Appreciate peneterating pattern form the Peripheral arterial tree.

3. Differentiate focal from diffuse form of the adenomyosis.