0:01

So now let's move to some cases as

0:03

we review the differential diagnosis

0:04

for abnormal endometrial thickness.

0:07

We'll start here with this 34-year-old who's

0:10

experiencing bleeding after intercourse.

0:12

We're going to start here with

0:13

a uterine sagittal sync eclipse.

0:15

I love my uterine sagittal sync eclipse as

0:17

you'll, you'll see throughout this talk.

0:19

We do have a sort of trilaminar appearance

0:22

to her endometrial stripe right here.

0:25

As we keep going, keep going, we see a

0:28

little bit of focal thickening right here.

0:30

Not super echogenic, but it looks

0:31

different than everywhere else, right?

0:34

Keep going, and there is

0:35

a second one right there.

0:36

This one is a little bit more echogenic,

0:38

kind of similar to myometrium here,

0:40

but it's clearly within the endometrial canal

0:42

as we continue to scroll through that.

0:45

So those are two things I want

0:46

to keep my eye on, two echogenic

0:48

lesions within the endometrium.

0:50

So with that, we'll go to the color

0:52

doppler cine sequence here, and you

0:55

can see lots of flow to the uterus.

0:59

A little bit of artifact there.

1:02

Some dirty shadowing from the rectum behind.

1:09

And it's going to be kind of right here.

1:13

There's our first little thickened

1:14

structure coming in right here.

1:15

I'm going to draw your eye before you

1:17

even see that echogenic structure.

1:18

You see this single feeding vessel

1:21

going from the endometrium right

1:24

into that structure right there.

1:26

And that can help confirm that this is a

1:28

polyp and not just be suggestive of a polyp.

1:31

So as we keep going through this sequence,

1:33

we're going to look for that second

1:34

lesion, which is up around this area.

1:36

You can see we're coming into it right there.

1:39

And in this case, you can see the flow

1:40

is coming from the anterior uterus.

1:42

We have a feeding vessel feeding that.

1:44

So then we can confidently say we have two

1:47

polyps in the endometrium, as opposed to

1:50

just saying likely polyps and correlate with

1:52

dysfunctional uterine bleeding, et cetera.

1:55

So a polyp is going to be usually echogenic.

1:58

you usually will see one feeding vessel.

2:00

If you see one vessel that is high specificity

2:03

versus a fibroid that can occasionally

2:05

be intracavitary, they're generally going

2:07

to have more than one feeding vessel.

2:10

And so just to review, a polyp is a hyperplastic

2:14

growth of the endometrial gland and stroma.

2:16

They may be asymptomatic or they may

2:18

have dysfunctional uterine bleeding.

2:20

So just because they don't have a history of

2:21

dysfunctional uterine bleeding, if you see

2:23

something that looks like this, it doesn't

2:25

mean that you don't call it as confidently.

2:27

You certainly can because they

2:28

may still be asymptomatic.