37 year old with primary infertility

 

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Doctor's Information

Name : firoozeh.fataneh.farnaz
Family : ahmadi.tehrani.akhbari
Affiliation :Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for
Academic Degree : radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :

 

Case Section

Genital Female Imaging

 

Patient's Information

Gender : Female
Age : 37

 

Clinical Summary

37 year old lady with primary infertility

 

Imaging Findings

Injection of contrast media through cervix and uterine cavity was done. Various outpuch in fundus and body of the uterus were seen which are typical characteristic of uterine adenomyosis. Arcquate uterus was detected . Spillage of contrast medium in left fallopian tube was seen but there is delayed spillage of contrast medium in right fallopian tube. Multiple, variable-sized diverticula extending perpendicularly from the endometrium localized into the uterine wall diffusely

 

Differential Diagnosis

Adenomyosis -endometrial hyperplasia (irregularities of the contours of the uterine cavity and variations in density of the uterine shadow) -cesarean sections (diverticula seen in HSG which is usually large and single) -Localized intravasation of contrast media into myometrial vascular channels

 

Final Diagnosis

Adenomyosis

 

Discussion (Related Text)

Adenomyosis is a histopathology diagnosis and depends on the presence of endometrial glands and/or stroma beneath the endomyometrial junction. It is a common gynecological disorder with an unclear etiology. It has been found in 10- 50% of autopsies and in 5.6% to 61.5% of surgical specimens.(1.2) It is usually asymptomatic, but may be presented by uterine bleeding, pain and infertility. Previously hysterosalpingography was one of the imaging modality used for the diagnosis of adenomyosis. In a series studied by Marshak (3) only 25 % of histologically proven cases of adenomyosis showed hysterographic abnormalities. The glandular elements may not fill by contrast because they lack continuity with the endometrium or because the communicating channel is blocked by secretions or blood. The characteristic uterographic signs of adenomyosis are: heterogeneity, increased echogenicity, decreased echogenicity, and anechoic lacunae or myometrial cysts 1) Slight to moderate enlargement of the uterine cavity. 2) Penetration of the contrast medium into the uterine musculature in the form of single or multiple delicate channels which are localized or generalized small diverticulum- like structures. 3) Local accumulation of contrast material in the myometrium can sometimes provide a honeycomb appearance. The ultrasound features of adenomyosis are often subtle and extremely variable. The most common findings on TVS in the patient with adenomyosis are poorly marginated hypoechogenic and heterogeneous areas (swiss-cheese appearance). Heterogeneous enlarged uterine cavity could be seen too. MRI, especially with T2-weighted images, has become an important imaging modality for uterine pathology because of its excellent soft tissue differentiation.

 

References

1- Kurjak A, Zalud I. The characterization of uterine tumors by transvaginal color Doppler. Ultrasound Obstet Gynecol. 1991 1;1(1):50-2. 2-Marshak RH, Eliasoph J. The roentgen findings in adenomyosis. Radiology. 1955; 64(6):846-51. 3- Shahrzad Gh.,Ahmadi F.,Vosough A.,Zafarani F., HYSTEROSALPINGOGRAPHY A Text and Atlas,First Edition,2009

 

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