Case Review: Ultrasound of Uterine Adenomyosis

Case Review: Ultrasound of Uterine Adenomyosis
In this radiology lecture, we review the ultrasound appearance of adenomyosis through three unique cases, including an MRI example.
Key teaching points include:
1) Adenomyosis results from ectopic endometrial tissue in myometrium. Leads to dysfunctional smooth muscle hyperplasia/hypertrophy surrounding ectopic glands.
2) Cause unknown.
3) Common, usually multiparous women of reproductive age.
4) Additional risk factors: Early menarche, short menstrual cycles, high BMI = High estrogen exposure.
5) Rarely seen in postmenopausal patients, unless treated with tamoxifen for breast cancer.
6) Often asymptomatic, but can present with menorrhagia, dysmenorrhea, dyspareunia, and chronic pelvic pain.
7) For diagnosing adenomyosis, transvaginal US much more sensitive and specific (89%) than transabdominal imaging.
8) Most specific US findings: Linear echogenic striations/nodules radiating from endometrium into inner myometrium. Tiny myometrial and subendometrial cysts = Fluid-filled glands.
9) Additional US findings: Enlarged, globular uterus with diffuse myometrial bulkiness, myometrial heterogeneity, irregular endometrial-myometrial interface, hyperechoic islands, and pencil-thin “venetian blind” or “rain shower” shadowing. Cine clips extremely helpful.
10) Adenomyosis can cause asymmetric myometrial thickening.
11) Focal adenomyosis (adenomyoma) has ill-defined margins compared to fibroids, typically elliptical as opposed to rounded in shape.
12) May see abnormal vascular flow: Increased vascularity with tortuous vessels penetrating myometrium. Helps differentiate adenomyosis from fibroids, which tend to displace vessels and show circumferential flow.
13) On US, thickened junctional zone may manifest as a hypoechoic halo surrounding echogenic endometrium.
14) MRI “traditionally” the modality of choice to diagnose adenomyosis, and junctional zone thickened to 12 mm or greater highly specific. May contain punctate T2 hyperintense cystic foci/T1 hyperintense hemorrhage.
15) However, modern TV US shows comparable accuracy to MRI with no statistical significance between sensitivities and specificities: “Transvaginal US should be considered the primary imaging modality for the diagnosis of adenomyosis.”*
16) Treatment: Pain management, tranexamic acid, OCPs, GnRH agonists.
17) If severe, not relieved medically, and no desire for fertility: Hysterectomy.
*Cunningham RK, Horrow MM, Smith RJ, et al. Adenomyosis: A Sonographic Diagnosis. RadioGraphics. 2018; 38:1576-1589
To learn more about the Samsung RS85 Prestige ultrasound system, please visit: www.bostonimaging.com/rs85-pr...
Click the TH-cam Community tab or follow on social media for bonus teaching material posted throughout the week!
Website: www.radiologistHQ.com
Video Podcast: bit.ly/radiologistHQ
Instagram: / radiologisthq
Facebook: / radiologistheadquarters
Twitter: / radiologisthq

[@LalaMama272]

My daughter has been dealing with endometriosis ancestry 14. Now w at 17 she was diagnosed with adenomyosis uteri.
She’s doubled over in pain bloating leg weakness pain, cramping nausea/vomiting even passing out!
I’m so grateful that we NOW HAVE A 9:15 NON PEDIATRIC Gyno ( yes my daughter was only 14 at diagnosis of endometriosis)
OUR GYNO NOW IS COMPETENT, WELL VERSED AND A KNOWLEDGEABLE DOCTOR🙏🏻 who actually listened and understands my daughters needs and pain symptoms. Unfortunately not all doctors are created equal.

[@endometriosisexplained1799]

Painful Asymmetric AM results from partial injury to endometrial-myometrial nerve plexus. Pain is from aberrant reinnervation in the insertions of uterosacral insertions.
Painless symmetric AM, common inChina is caused by COMPLETE avulsion of uterosacral ligts containing uterine and tubal nerves. It is usually caused by recurrent teenage medical or surgical abortions. (We found 31 cases in 3 months near Shanghai - they come to hysterectomy in mid-40’s.

[@GynaecologyUltrasound]

Thank you - a lovely presentation on adenomyosis. I would just add that where you see adenomyosis, look for deep endometriosis, as it’s often (but not invariably) present.

[@Radquarters]

Thank you and thanks for sharing! Excellent point. And sorry for the delay in replying :)

[@johnweak3198]

Excellent explanation!!

[@Radquarters]

Thank you, appreciate that!

[@shahramhadidchi8752]

Thank you ! Great presentation.

[@Radquarters]

Glad you enjoyed it!

[@basschica]

Thank you for this video. It proves the last Dr I went to was a gaslighting gaslighter who gaslighted. In 2018 I was dx'd with adenomyosis via tvus. I moved and have had 2 tvus @ a new practice (last yr dx'd w/polyp & had d&c & one this yr the day before surgical consult appt & dx'd w/hemorrhagic cyst by the other Dr I see there). Even to my untrained eye I can see venetian blinds for days on the recent one I requested a copy of lab reoort from. The Dr@ surgery consult insinuated I was lying about adenomyosis dx & then the ruptured hemorrhagic cyst seen on the new tvus by my other Dr there THE DAY BEFORE which I can say with certainty I know it ruptured about 3 weeks before the appt because I was in debilitating pain surging for hours... She said, "Well maybe it was just ovulation." Needless to say I fired her, have my records & will be going to a new Dr next week.

[@user-yl7vl7kg7x]

Radiology is life

[@Radquarters]

I concur!

[@dr.eltiganiabdelmagid1672]

WELL DONE

[@Radquarters]

Thank you!

[@azharsyed1867]

Thanks

[@Radquarters]

You're welcome, and thank you for watching!

[@phyothihanyein4989]

Thank you

[@Radquarters]

You're welcome!

[@nataliem1019]

Me trying to keep up 😅

[@Radquarters]

Thanks for watching!