Diffuse uterine adenomyosis is the most common of uterine adenomyosis. For the discussion of adenomyosis, please refer to the parent article - adenomyosis of the uterus.
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Epidemiology
Diffuse adenomyosis may account for ~2/3rd of uterine adenomyosis.
Pathology
Diffuse adenomyosis can be even or uneven in involvement and, therefore, it is subclassified as either symmetrical or asymmetrical 3.
Radiographic features
Hysterosalpingogram
Not a commonly used technique in diagnosing adenomyosis. It may show diffuse irregularity of uterine cavity contour with multiple irregular branching diverticula of contrast radiating into the myometrium, seen in about 25% of cases. A honeycomb appearance may be seen due to accumulation of contrast in these diverticula.
Ultrasound
Non-specific but may be seen as heterogeneity in myometrial echotexture.
Myometrial bulkiness however may be asymmetric and typically can affect the fundal region and posterior wall 4.
MRI
On T2-weighted MR images, diffuse adenomyosis usually manifests as diffuse thickening of the endometrial-myometrial junctional zone (many use the thickness cut off of ~12 mm) with homogeneous low signal intensity 1.