0:01

Our next case is of a 45-year-old patient

0:04

with heavy bleeding times three years.

0:06

She is a premenopausal at this point.

0:08

So again, let's just start with

0:09

our sagittal imaging right here.

0:11

And as we scan through here, we can see some

0:13

asymmetric myometrial thickening, right?

0:15

The anterior myometrium is much thinner

0:18

than the myometrium posteriorly.

0:20

And this is a sagittal image.

0:22

So you can't really otherwise explain why

0:24

this is so much thicker than anterior here.

0:27

Also, as we scroll through here, now

0:29

you're going to see that Venetian blind.

0:30

You can see that alternating shadow

0:32

and increased echogenicity right here.

0:35

In this case, it's not tracking back

0:37

to the arcuate arteries, either very

0:38

anterior or posterior right here.

0:40

It's tracking to this process right here.

0:42

So this is asymmetric myometrial thickening.

0:45

We have Venetian blind sign here.

0:48

And then we can look to see if we

0:49

find any other signs as well, such as,

0:51

you know, very small cystic spaces.

0:53

As we can see some of them within this

0:56

structure, like the little one right there.

0:59

Little one right here, little one right there.

1:00

So these are not, you know, along the

1:03

interface of the myometrium and endometrium.

1:04

These are in this structure.

1:07

So you might say, could this just be a fibroid?

1:09

Fibroids can shadow, but they don't often

1:11

have this Venetian blind appearance.

1:13

The other thing is that they

1:14

should have a well-defined border.

1:16

You should be able to measure where

1:17

this starts and where this ends.

1:19

And I would argue here, it just kind of

1:21

blends into the tissue next to it right there.

1:23

I can't tell you where this

1:24

starts and where this ends.

1:26

It's blurred, no well-defined borders.

1:28

So this is going to be adenomyosis right here.

1:32

So, if you weren't entirely sure, we threw on

1:34

some color Doppler, so in this cine clip, still

1:37

sagittal, gives you a beautiful example of

1:40

these penetrating tortuous vessels right here.

1:43

Look at those, it's completely

1:44

asymmetric where you just see, you know,

1:45

dots of vascularity here and there.

1:48

This is vessels.

1:49

The arcuate arteries right here that

1:51

are filling as they should, but you have

1:53

this very different appearance of these

1:54

penetrating little bit torturous vessels

1:57

heading right into this structure right here.

2:00

This is not circumferential

2:01

vascularity of a fibroid.

2:03

This is not a classic appearance for that.

2:06

This is the penetrating vascularity

2:09

that is classic for adenomyosis.

2:11

So this is focal adenomyosis or

2:14

an adenomyoma potentially of the

2:16

posterior uterine body right here.

2:18

Classic appearance for it.