Diagnostic Ultrasound - Abdomen and Pelvis
Enlarged Uterus Leiomyoma Adenomyosis (Left) Longitudinal US shows an enlarged uterus secondary to multiple leiomyomas. Two are visible ſt on this image, with typical imaging findings including well-defined borders and internal heterogeneity and shadowing. The thin endometrium is visible centrally . (Right) Transabdominal sagittal ultrasound shows a uterus with adenomyosis. The posterior myometrium st is much thicker than the anterior myometrium ſt. The endometrium is normal . Differential Diagnoses: Female Pelvis Adenomyosis Cervical Stenosis (Left) Transverse US shows pseudothickening of the endometrium ſt and uterine enlargement. Alternating bands of shadowing and increased through transmission are typical of adenomyosis. (Right) Longitudinal US of the lower uterine segment shows expansion of the endometrial cavity ſt with echogenic material st, consistent with hematocolpos in this patient with cervical stenosis. Endometrial Cancer Cervical Mass (Left) Transverse US in the same patient shows a necrotic mass with peripheral color flow st. There is myometrial thinning ſt, suggesting deep muscle invasion. (Right) Longitudinal transvaginal ultrasound shows a large, lobulated, solid cervical mass ſt representing cervical carcinoma. There was no endometrial cavity fluid st. 1047
Abnormal Endometrium Differential Diagnoses: Female Pelvis DIFFERENTIAL DIAGNOSIS Common • Secretory Phase Endometrium • Pregnancy and Complications • Retained Products of Conception • Mimic of Endometrial Thickening ○ Submucosal Leiomyoma ○ Intramural Leiomyoma ○ Adenomyosis ○ Hematometra • Endometrial Polyps Less Common • Endometrial Hyperplasia • Endometrial Cancer • Tamoxifen-Induced Changes Rare but Important • Endometritis • Unopposed Estrogen Use • Polycystic Ovary Syndrome • Endometrial Stromal Sarcoma ESSENTIAL INFORMATION Key Differential Diagnosis Issues • Is patient postpartum? ○ Endometritis ○ Retained products of conception • Is thickening focal? ○ Endometrial polyps ○ Leiomyoma, submucosal ○ Endometrial cancer ○ Endometrial hyperplasia ○ Retained products of conception • Does patient have abnormal bleeding? ○ Endometrial polyps ○ Leiomyoma, submucosal ○ Leiomyoma, intramural ○ Endometrial hyperplasia ○ Endometrial cancer ○ Retained products of conception • Is endometrial-myometrial interface indistinct? ○ Endometrial cancer ○ Leiomyoma, submucosal ○ Adenomyosis Helpful Clues for Common Diagnoses • Secretory Phase Endometrium ○ After ovulation in second 1/2 of menstrual cycle, endometrium can be thick, heterogeneous, and echogenic ○ Follow-up early in subsequent menstrual cycle will show thin endometrium • Pregnancy and Complications ○ Positive urine/serum human chorionic gonadotropin – Normal early pregnancy – Miscarriage – Ectopic pregnancy – Hydatidiform mole, complete mole – Hydatidiform mole, partial mole • Retained Products of Conception ○ Focal endometrial echogenic lesion ○ Fluid ± clot ○ May have calcifications ○ May have low-resistance arterial flow, but lack of flow does not exclude diagnosis • Submucosal Leiomyoma ○ Submucosal lesions > 50% within endometrium ○ Iso- or hypoechoic well-marginated lesion ○ Less echogenic than endometrium ○ Posterior shadowing ○ Multiple feeding vessels • Intramural Leiomyoma ○ Not true endometrial lesion but can cause appearance of endometrial thickening ○ Iso- or hypoechoic lesion distorting or obscuring endometrium ○ Shadowing behind leiomyoma • Adenomyosis ○ Poor definition of endometrial myometrial interface makes it difficult to evaluate and measure endometrium ○ Look for streaky linear hypoechoic myometrial bands and subendometrial cysts ○ Asymmetric uterine enlargement ○ Tender uterus • Hematometra ○ Look for underlying cause of obstruction – Uterine duplication anomaly – Leiomyoma – Endometrial cancer – Cervical cancer – If thin surrounding endometrium and no obstructing lesion, cervical stenosis is diagnosis of exclusion • Endometrial Polyps ○ Focal endometrial lesion ○ Typically more echogenic than surrounding endometrium ○ May have internal cysts ○ Stalk with single feeding vessel ○ May have broad base ○ Frequently multiple ○ Smooth margins Helpful Clues for Less Common Diagnoses • Endometrial Hyperplasia ○ Peri- or postmenopausal woman ○ Association with polycystic ovarian syndrome ○ ± cystic spaces ○ Typically diffuse but may be focal • Endometrial Cancer ○ Early stage – Appears as focal endometrial lesion ○ Later stage – Invades myometrium, leads to indistinct endometrialmyometrial interface ○ Irregular thickened heterogeneous endometrium • Tamoxifen-Induced Changes ○ Paradoxical estrogenic effect on endometrium increases with ↑ dose and time of treatment 1048
- Page 1018 and 1019: Focal Lesion in Prostate Müllerian
- Page 1020 and 1021: PART III SECTION 9 Bowel Bowel Wall
- Page 1022 and 1023: Bowel Wall Thickening - Distal ileu
- Page 1024 and 1025: Bowel Wall Thickening Crohn Disease
- Page 1026 and 1027: Bowel Wall Thickening Clostridium D
- Page 1028 and 1029: PART III SECTION 10 Scrotum 1008
- Page 1030 and 1031: Diffuse Testicular Enlargement Test
- Page 1032 and 1033: Decreased Testicular Size Testicula
- Page 1034 and 1035: Testicular Calcifications Sertoli C
- Page 1036 and 1037: Focal Testicular Mass - Most common
- Page 1038 and 1039: Focal Testicular Mass Testicular Ly
- Page 1040 and 1041: Focal Extratesticular Mass - 3-50 m
- Page 1042 and 1043: Focal Extratesticular Mass Inguinal
- Page 1044 and 1045: Focal Extratesticular Mass Liposarc
- Page 1046 and 1047: Extratesticular Cystic Mass Varicoc
- Page 1048 and 1049: PART III SECTION 11 Female Pelvis
- Page 1050 and 1051: Cystic Adnexal Mass □ Hemorrhagic
- Page 1052 and 1053: Cystic Adnexal Mass Dermoid (Mature
- Page 1054 and 1055: Solid Adnexal Mass - May masquerade
- Page 1056 and 1057: Solid Adnexal Mass Fibrothecoma Hem
- Page 1058 and 1059: Extraovarian Adnexal Mass Helpful C
- Page 1060 and 1061: Extraovarian Adnexal Mass Paraovari
- Page 1062 and 1063: Extraovarian Adnexal Mass Lymph Nod
- Page 1064 and 1065: Enlarged Ovary - Often bilateral (5
- Page 1066 and 1067: Enlarged Ovary Theca Lutein Cysts T
- Page 1070 and 1071: Abnormal Endometrium ○ Multiple e
- Page 1072 and 1073: Abnormal Endometrium Pregnancy and
- Page 1074 and 1075: Abnormal Endometrium Tamoxifen-Indu
- Page 1076 and 1077: INDEX A Abdominal aorta, 34, 40, 42
- Page 1078 and 1079: INDEX - myelolipoma vs., 590 - stag
- Page 1080 and 1081: INDEX Biliary cyst. See Choledochal
- Page 1082 and 1083: INDEX Caroli disease, 204-207 - bil
- Page 1084 and 1085: INDEX - solid renal mass vs., 968 -
- Page 1086 and 1087: INDEX diagnostic checklist, 839 dif
- Page 1088 and 1089: INDEX Efferent ductules, 130 Ejacul
- Page 1090 and 1091: INDEX Focal myometrial contraction
- Page 1092 and 1093: INDEX - hydrocele vs., 715 - sperma
- Page 1094 and 1095: INDEX Hepatocellular carcinoma (HCC
- Page 1096 and 1097: INDEX Inflammatory pseudotumor, sol
- Page 1098 and 1099: INDEX - focal extratesticular mass
- Page 1100 and 1101: INDEX irregular hepatic surface vs.
- Page 1102 and 1103: INDEX Normal postpartum, enlarged u
- Page 1104 and 1105: INDEX Pararenal fat, posterior, 64
- Page 1106 and 1107: INDEX - inflammatory, gallbladder c
- Page 1108 and 1109: INDEX Pyelogenic cyst - dilated ren
- Page 1110 and 1111: INDEX Renal infection - renal lymph
- Page 1112 and 1113: INDEX - macrocystic variant, mucino
- Page 1114 and 1115: INDEX - right, 92 lesser sac, 93 Su
- Page 1116 and 1117: INDEX Tunica albuginea cyst - calci
Enlarged Uterus<br />
Leiomyoma<br />
Adenomyosis<br />
(Left) Longitudinal US shows<br />
an enlarged uterus secondary<br />
to multiple leiomyomas. Two<br />
are visible ſt on this image,<br />
with typical imaging findings<br />
including well-defined borders<br />
<strong>and</strong> internal heterogeneity<br />
<strong>and</strong> shadowing. The thin<br />
endometrium is visible<br />
centrally . (Right)<br />
Transabdominal sagittal<br />
ultrasound shows a uterus<br />
with adenomyosis. The<br />
posterior myometrium st is<br />
much thicker than the anterior<br />
myometrium ſt. The<br />
endometrium is normal .<br />
Differential Diagnoses: Female <strong>Pelvis</strong><br />
Adenomyosis<br />
Cervical Stenosis<br />
(Left) Transverse US shows<br />
pseudothickening of the<br />
endometrium ſt <strong>and</strong> uterine<br />
enlargement. Alternating<br />
b<strong>and</strong>s of shadowing <strong>and</strong><br />
increased through<br />
transmission are typical of<br />
adenomyosis. (Right)<br />
Longitudinal US of the lower<br />
uterine segment shows<br />
expansion of the endometrial<br />
cavity ſt with echogenic<br />
material st, consistent with<br />
hematocolpos in this patient<br />
with cervical stenosis.<br />
Endometrial Cancer<br />
Cervical Mass<br />
(Left) Transverse US in the<br />
same patient shows a necrotic<br />
mass with peripheral color<br />
flow st. There is myometrial<br />
thinning ſt, suggesting deep<br />
muscle invasion. (Right)<br />
Longitudinal transvaginal<br />
ultrasound shows a large,<br />
lobulated, solid cervical mass<br />
ſt representing cervical<br />
carcinoma. There was no<br />
endometrial cavity fluid st.<br />
1047
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