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 ADENOMYOSIS  MERCURY IMAGING INSTITUTE  SCO 172-173 SEC 9C  CHANDIGARH MERCURY IMAGING CENTRE  SCO 16-17 SEC 20D CHANDIGARH 22 YEAR OLD FEMALE WITH  POG OF 5WKS . EPISODIC PAIN IN THE LOWER ABDOMEN.
DIFFERENTIATE                           ADENOMYOSIS                                      FROM LEIOMYOMA
FEATURES OF ADENOMYOSIS  Echogenecity of mass---------- Hyperechoic Borders of the mass------------ill -defined Vascularity of the lesion------- Penetrating    Size of uterus---------------------Bulky with asymmetrical lobulations ( anterior and posetrior).     Junctional zone-------------------Thick. ( >8mm ( 8-12mm) >12mm) ( MR sagittal plane T2w sequence  gives best assesment of junctional zone) Subendometrial / Intramyometrial cysts  -Present .
FEATURES OF   LEIOMYOMA   Echogenecity of mass---------- Hypoechoic Borders of the mass------------Defined Vascularity of the lesion------- Peripheral    Junctional zone------------------- Normal. Subendometrial / Intramyometrial cysts- Not present .
Present case ......................  ,[object Object]
Heterogenous pattern of the Myometrium
Intramyometrialpeneteratingvascularity.
Congested  venous system.
Focal defined hypoechoic areas – Leiomyomas
G sac – 5wks with                    ? Viability----Follow up advised . ,[object Object]
CONGESTED TORTUOUS VESSELS – INTRAMYOMETRIAL . PENETERATING PATTERN FOCAL HYPOECHOIC AREAS APPRECIATED IN THE MYOMETRIUM WITH DEFINED BORDERS – CORROBORATIVE WITH  SMALL LEIOMYOMA.
G SAC WITH NO FETAL NODE/ NO YOLK SAC. CORROBORATES WITH POG 5WKS ODAYS ......FOLLOW UP FOR VIABILITY   HETEROGENOUS  ECHOPATTERN OF THE MYOMETRIUM
MAGNIFIED VIEW OF THE G SAC   SINGLE LINER  ADENOMYOSIS CAN PREDISPOSE TO INTRAMYOMETRIAL ECTOPIC PREGNANCY
BULKY UTERUS  WITH LOBULATED OUTLINE
PENETERATING   PATTERN OF THE VASCULATURE

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Pregnancy with adenomyosis and leiomyoma with component of pelvic congestion

  • 1. ADENOMYOSIS MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH 22 YEAR OLD FEMALE WITH POG OF 5WKS . EPISODIC PAIN IN THE LOWER ABDOMEN.
  • 2. DIFFERENTIATE ADENOMYOSIS FROM LEIOMYOMA
  • 3. FEATURES OF ADENOMYOSIS Echogenecity of mass---------- Hyperechoic Borders of the mass------------ill -defined Vascularity of the lesion------- Penetrating Size of uterus---------------------Bulky with asymmetrical lobulations ( anterior and posetrior). Junctional zone-------------------Thick. ( >8mm ( 8-12mm) >12mm) ( MR sagittal plane T2w sequence gives best assesment of junctional zone) Subendometrial / Intramyometrial cysts -Present .
  • 4. FEATURES OF LEIOMYOMA Echogenecity of mass---------- Hypoechoic Borders of the mass------------Defined Vascularity of the lesion------- Peripheral Junctional zone------------------- Normal. Subendometrial / Intramyometrial cysts- Not present .
  • 5.
  • 6. Heterogenous pattern of the Myometrium
  • 9. Focal defined hypoechoic areas – Leiomyomas
  • 10.
  • 11. CONGESTED TORTUOUS VESSELS – INTRAMYOMETRIAL . PENETERATING PATTERN FOCAL HYPOECHOIC AREAS APPRECIATED IN THE MYOMETRIUM WITH DEFINED BORDERS – CORROBORATIVE WITH SMALL LEIOMYOMA.
  • 12. G SAC WITH NO FETAL NODE/ NO YOLK SAC. CORROBORATES WITH POG 5WKS ODAYS ......FOLLOW UP FOR VIABILITY HETEROGENOUS ECHOPATTERN OF THE MYOMETRIUM
  • 13. MAGNIFIED VIEW OF THE G SAC SINGLE LINER ADENOMYOSIS CAN PREDISPOSE TO INTRAMYOMETRIAL ECTOPIC PREGNANCY
  • 14. BULKY UTERUS WITH LOBULATED OUTLINE
  • 15. PENETERATING PATTERN OF THE VASCULATURE
  • 16. VALSALVAE ---- Tortuos venous channels- normal response. – Pregnanacy with adenomyosis – Associated component of pelvic congestion.
  • 17. LOW RESISTANCE ARTERIAL TREE.- PREGNANT STATE WITH ASSOCIATED ADENOMYOSIS
  • 18. ECTOPIC ENDOMETRIAL GLAND WITH SMOOTH MUSCLE HYPERPLASIA
  • 19. LESSON LEARNT Differentiate between Adenomyosis and Leiomyoma. Appreciate peneterating pattern form the Peripheral arterial tree. Differentiate focal from diffuse form of the adenomyosis.