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Uterine adenomyosis

Case contributed by Martin Bundi Rugendo
Diagnosis almost certain

Presentation

Menorrhagia and pelvic pain. Pelvic tenderness on examination

Patient Data

Age: 35 years
Gender: Female

Transabdominal scan

ultrasound

The diffuse posterior myometrial wall thickening is noted in comparison to the anterior wall, resulting in a large uterus.

Endometrial-posterior myometrial junctional delineation is poor.

The ovaries were unremarkable.

Transvaginal scan

ultrasound

There is asymmetrical diffuse posterior myometrial wall thickening but no discernible mass. There are also echogenic linear striations that give the rain shower appearance.

Endo-vaginal sonograms revealed poor endometrial myometrial junction, as well as small sub-endometrial cysts reflecting fluid-filled glands. Within the posterior myometrial wall, there are hyperechoic islands indicative of the ectopic endometrial glands. Color Doppler interrogation exhibited increased vascularity.

Case Discussion

Adenomyosis is defined by the presence of endometrial tissue within the myometrium. It is associated with heavy menstrual bleeding, pelvic pain, and uterine hypertrophy.

It should be noted that the sonographic appearance of adenomyosis might be confused with other disorders such as leiomyomas or endometrial polyps. As a result, a thorough evaluation and detailed medical history, as well as additional diagnostic imaging procedures such as MRI, may be required to establish an accurate diagnosis.

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