Pregnancy with adenomyosis and leiomyoma with component of pelvic congestion
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Transcript of Pregnancy with adenomyosis and leiomyoma with component of pelvic congestion
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.