Presentation
Chronic significant pelvic pain for one year.
Patient Data
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.