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Diffuse adenomyosis

Case contributed by Hidayatullah Hamidi
Diagnosis almost certain

Presentation

Chronic significant pelvic pain for one year.

Patient Data

Age: 35 years
Gender: Female
mri

The uterus is bulky and appears retroverted and retroflexed.

Diffuse thickening and irregularity of the endometrium myometrial junction zone are noted with T2 high signal striations. A unilateral wall thickness of 1.5 cm is seen in the posterior wall of the uterus.

Tiny foci of high T1 signal are seen, indicating menstrual hemorrhage into the ectopic endometrial tissues.

A note is made for disc dehydration and posterior disc bulge at L5/S1 level causing compression over the thecal sac and lateral recesses.

Case Discussion

Adenomyosis is a known cause of chronic pelvic pain. Other clinical presentations can be dysmenorrhea, menorrhagia, dyspareunia, and menometrorrhagia.

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