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Reference: article/405335-imaging
Rice grain in cervix in child:
This patient, a 3 yr. old female child had history of sitting and playing on a pile of rice grains. Following this incident, she complained of pain in the pelvis and perineum. Sonography of the pelvis in this child showed an echogenic lesion (echogenic focus) of 4 to 5mm. in the cervix of the uterus. Color Doppler images showed typical twinkling artifact around this lesion. There was intense posterior acoustic shadowing beyond this lesion. Given the history of the child, these ultrasound images suggest foreign body in the cervix, which in this case may be a rice grain. Sonographic images are courtesy of Dr. Vikas Shukla, MD, India.
Reference: files/Case%20Vol-6-1.pdf
AVM inside the uterus:
These transvaginal ultrasound and Color Doppler images of the uterus show inhomogenous hypoechoic lesions close to and within the endometrium of this female patient. Color Doppler, in addition, shows a tangle or chaotic pattern multiple dilated vessels in this region of the uterus, extending into its myometrium. Spectral Doppler shows high velocity flow pattern within these vessels, with low resistance (or high diastolic flow). This sonographic appearance is typical of AVM (arterio-venous malformation) of the uterus. This has to differentiated from GTD (gestational trophoblastic disease/ vesicular mole etc.) and retained products of conception. All images are courtesy of Dr. Dilraj Gandhi, MD, India. The machine used here was the GE Voluson.
Reference: 1) cgi/reprint/25/11/1387 (free article and images)
2) content/22/1/47.full.pdf+html (free article and images)
Transvaginal ultrasound and Color Doppler images of the uterus in this patient show: irregular and asymmetric, diffuse enlargement of the uterus, poorly defined myometrial- endometrial interface (poorly defined endometrium), inhomogenous myometrium, streaky acoustic shadowing posterior to the uterus and irregular inhomogenous increase in vascularity of the myometrium (see Color Doppler image of uterus on right). There is also a poorly defined hypoechoic mass in the posterior myometrium. These ultrasound findings are suggestive of adenomyosis of the uterus. Sometimes hypoechoic/ anechoic cystic areas may also be seen in the myometrium in this disease (not seen here). The main differential diagnosis in this case is fibroid of the uterus. However, fibroids are well defined, more or less homogenous masses and do not produce streaky (dirty) shadows. Also, on transvaginal sonography fibroids are usually non-tender on probe pressure. Fibroids also usually have a hypoechoic halo or margin due to compressed vessels. Adenomyosis never contains calcific areas. Ultrasound images are courtesy of Dr. Latha Natarajan, India.
Reference: viewarticle/459772 (free article)
This transabdominal ultrasound image shows a large (bulky) uterus with a diffusely infiltrative, inhomogenous appearance of the myometrium with dirty, streaky shadowing posteriorly. The uterus shows a globular shape with the endometrium almost obscured. These features are typically seen in adenomyosis. However, both fibroids/ leiomyoma of the uterus can simultaneously be present with diffuse adenomyosis as in this case. Ultrasound image courtesy of Vikas Shukla, MD, India.
This young lady has a history of severe pain during menses. Transvaginal ultrasound imaging shows a simple cyst of the left ovary. The uterus appears bulky with thickened endometrium (12 to 14 mm.). In addition, there is a hyperechoic, inhomogenous lesion posterior to the endometrium and compressing upon it. This lesion also shows some cystic areas within it. Cystic lesions are also present in the endometrium. Myometrial cysts and cystic lesions are characteristic of adenomyosis of the uterus. The hyperechoic myometrial areas are caused by the migration of endometrial tissue into the myometrium. The hypoechoic areas within the adenomyotic lesions are the result of hyperplasia of the myometrial smooth muscle around the ectopic endometrial tissue. The actual measure of the adenomyosis being hypoechoic or hyperechoic depends on the ratio of smooth muscle hyperplasia (hypoechoic) to the endometrial tissue (hyperechoic) within the lesion in the myometrium.
The above color Doppler and Power Doppler images further confirm the highly vascular nature of the lesion. These ultrasound appearances are diagnostic of adenomyosis of the uterus. The left ovarian cyst was just an incidental finding, but not the cause of dysmenorrhea.
Color Doppler videos of this case are at:
2011/03/adenomyosis-of-uterus.html
This young adult female patient underwent D &C (dilatation and curettage) some time ago. Presently, she presented with abdominal pain. The sagittal ultrasound images of the uterus show small amount of fluid inside the endometrial cavity with adhesions between the anterior and posterior walls of the cavity (arrowheads). These ultrasound findings are diagnostic of Asherman's syndrome or uterine synechia/ adhesions. Synechiae of the uterus are typically seen following a D & C of the uterus. The cause is possibly adhesions or scarring within the walls of the raw surfaces of the uterine cavity. This condition is usually treated by surgical intervention, using a procedure called adhesiolysis during hysteroscopy. Untreated, this condition can result in infertility and amenorrhea. Ultrasound images are courtesy of Dr. Vikas Shukla, MD, India.
Reference: /Asherman%27s_syndrome
issues/octdec05/article/article13.html
Transabdominal ultrasound scan in this middle aged lady showed a bulky uterus with a small hypoechoic lesion in the anterior wall of the fundus. Possibly, this is a cases of adenomyosis of the uterus. But, this alone did not appear to explain the cause of her symptoms. Transvaginal ultrasound images revealed a cervical pathology. See grey scale images below:
Transvaginal ultrasound images of the cervix (sagittal) show a 6 x 15 mm. long, echogenic mass in the endocervical canal. The diagnostic possibilities here appear to be prolapsed endometrial polyp (descending from the uterine cavity above) or a small endocervical fibroid. However, there appeared to be no extension of the mass upwards, with its boundaries, well within the endocervix. Transvaginal color Doppler ultrasound images in both sagittal and transverse sections revealed:
Clearly this is a very vascular fleshy mass within the endocervix, the most probable diagnosis being a cervica, pedunculated polyp. Here are a couple more Power doppler and Spectral Doppler trace images:
There is pulsatile flow within the vessels in the cervical canal, further confirming the highly vascular nature of the mass. Final diagnosis - pedunculated polyp of the cervix.
Reference: doi/10.1002/uog.1992/pdf (free article and images).
For a color Doppler ultrasound video demonstration of this case see:
2010/11/pedunculated-cervical-polyp-ultrasound.html
