0:01

Our next case is of a 69-year-old

0:03

patient who presented to the ED

0:04

with abnormal vaginal bleeding.

0:07

Just going to show you our

0:08

sagittal uterus imaging right here.

0:13

And so we have a couple incidental findings.

0:15

She definitely has fluid in the endometrial

0:17

canal and maybe some nodularity right here.

0:20

Could that be a polyp?

0:21

Could that be a little bit of blood products?

0:23

We have lots of echogenic foci

0:25

out in the periphery.

0:26

These may be calcified vessels given her age.

0:29

And then we have this focal mass-like,

0:32

very echogenic structure back here in the myometrium.

0:36

And so when you're thinking on

0:37

ultrasound, what's your differential

0:38

for very bright structures?

0:40

We have calcium, which this is not.

0:42

If this is this heavily calcified and

0:44

this large, it should be shadowing.

0:46

And this is clearly not shadowing.

0:49

You can think about air.

0:50

However, similar type of thing.

0:52

If you have this much large kind of globule of

0:55

air, you would see dirty shadowing behind it.

0:57

You wouldn't see the

0:58

structures behind it nicely.

0:59

So this isn't air.

1:01

Other things that are bright on ultrasound,

1:03

of course, are going to be fat.

1:05

So this is probably fat in

1:06

the uterus or a lipoleiomyoma.

1:09

So this is fatty degeneration of a fibroid.

1:12

So here's your color Doppler imaging.

1:14

We're not seeing too much color Doppler flow

1:16

in there, nor do we actually see color Doppler

1:18

flow in the structure within the endometrium.

1:20

So it might just be a little

1:21

bit of blood products in there.

1:23

Patient also had a CT scan.

1:26

I like to look at the uterus

1:27

on your sagittal images.

1:30

And again, this is not

1:31

the greatest for contrast

1:33

purposes, but it's good enough to diagnose.

1:35

So here you can see right here, we have this

1:37

hypodense structure in the anterior uterus

1:40

and put a Hounsfield unit on it, negative

1:43

nine, which is going to be very similar to

1:45

the mesenteric fat or subcutaneous fat that

1:48

confirms if you weren't 100% sure.

1:50

We now know this is a fatty lesion.

1:52

This is a lipoleiomyoma.

1:54

56 00:01:57,635 --> 00:01:57,955 Alright.

1:57

One last thing to consider here

1:59

too, because this is a nice example.

2:01

We talked earlier in this about retroversion,

2:04

anteversion, and that kind of stuff.

2:06

So this is a retroverted

2:08

uterus, and it is retroflexed.

2:11

And that means that this is still going

2:12

to be the anterior part of the uterus.

2:14

This is not posterior, and it proves

2:16

that too in the CT right here.

2:17

It's in the anterior uterus, not the

2:19

posterior wall of the uterine structure.