Presentation
Lower abdominal pain with dysmenorrhea.
Patient Data
Uterus is bulky and anteverted.
There is diffuse thickening of fundus (4 cms in thickness), posterior wall (5.2 cms) & anterior wall of upper uterine segment (2.3 cms) with numerous T2 hyperintense foci (which represent endometrial glands). There are also few T1 hyperintense foci within the thickened myometrium –representing hemorrhagic foci. There is associated thickening of the junctional zone. These features are suggestive of diffuse adenomyosis.
Left ovary shows T2 hypointense and T1 hyperintense cyst - representing hemorrhagic or endometriotic cyst. Left ovary is adhered to the postero-superior surface of uterus, likely due to underlying endometriosis.
Right ovary is seen separately from the uterus and shows dominant follicles.
Case Discussion
Adenomyosis refers to presence of endometrial glands and stroma within the myometrium. It can be diffuse or focal. Focal adenomyomas can be difficult to differentiate from leiomyomas. The characteristic MRI features of diffuse adenomyosis include diffuse asymmetrical thickening of myometrium with thickened junctional zone (>12 mm) and presence of multiple small T2 hyperintense foci within the thickened myometrium.
Adenomyosis can be associated with ovarian endometriomas and pelvic endometriosis.