Diagnostic Ultrasound - Abdomen and Pelvis

Endometrial Polyp
Diagnoses: Female Pelvis
TERMINOLOGY
• Focal hyperplastic overgrowth of endometrial tissue
• Saline infusion sonohysterography: SHG, SIS
IMAGING
• Focal echogenic endometrial thickening or mass with
feeding vessel
• Schedule US/SHG within first 10 days of menstrual cycle in
menstruating females
• Ultrasound features
○ Echogenic area in endometrium during proliferative
phase of menstrual cycle
○ Hyperechoic line sign: Full/partial echogenic rim around
area of endometrial thickening highly specific for
endocavitary mass
○ Color Doppler: Single feeding vessel in stalk
• Saline infusion sonohysterography
○ Best technique to differentiate focal from diffuse
endometrial thickening
KEY FACTS
TOP DIFFERENTIAL DIAGNOSES
• Endometrial carcinoma
• Endometrial hyperplasia
• Submucosal fibroid
• Gestational trophoblastic disease
• Retained products of conception
CLINICAL ISSUES
• Etiology of up to 30% of cases of postmenopausal bleeding
DIAGNOSTIC CHECKLIST
• SHG for endometrial thickening, particularly if no cysts or
feeding vessel on US
• MR/TVS/color Doppler may help to distinguish polyp from
carcinoma
• Cancer may coexist with benign disease
○ Biopsy required: Benign polyps cannot be differentiated
from polyps with atypical hyperplasia
(Left) Transverse transvaginal
color Doppler US shows an
endometrial polyp ſt with a
vascular pedicle denoting
the location of attachment to
the endometrial wall. Internal
cystic spaces , as in this
case, are typically associated
with a benign etiology. (Right)
Longitudinal transvaginal
ultrasound shows an
elongated polyp ſt, partially
surrounded by fluid , filling
the endometrial cavity and
prolapsing through the
cervical canal st.
(Left) Transverse transvaginal
ultrasound during saline
infusion sonohysterography
demonstrates multiple sessile
polyps ſt within the
endometrial cavity. Four are
visible on this single image.
(Right) Sagittal transvaginal
ultrasound during saline
infusion sonohysterography
demonstrates a single
pedunculated polyp within the
cavity ſt. Color Doppler
shows the vascular pedicle ,
denoting the site of
attachment. The echogenic
line sign is seen at multiple
interfaces lying perpendicular
to the ultrasound beam .
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