Adenomyosis uterus with hematometra

Case contributed by Dr Chris O'Donnell

Presentation

No periods for months. Infertility

Patient Data

Age: 30 years
Gender: Female
Ultrasound

Expanded endometrium containing a fluid/fluid level on the longitudonal image and no blood flow on color Doppler.  Note thickening of the posterior uterine wall with the typical "venetian blind" echo pattern of adenomyosis (best seen on the transverse image)

Poorly defined mass in the posterior uterine body causing obstruction to the endometrial cavity and resultant hematometra.  There is a generalized increase in vascularity to the uterus (arrows).Note the 3 layers in the blood ie dependent red cells (containing metHb as low T2 signal), serum as supernatant (high T2 signal) and an intervening thin grey layer (ie the buffy coat of platelets).

Case Discussion

Adenomyosis of the uterus is less well-defined on MRI and US than fibroids and has a signature pattern of "venetian blind" alternating echogenity on ultrasound.  On MRI it is characterized by a poorly defined thickening of the uterine wall with small cystic spaces.

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