5/27/2023 0 Comments Saline sonogramOnline supplemental material is available for this article. This article reviews the pathophysiology of adenomyosis and correlates it with the US findings, highlights specific causes of adenomyosis, and describes how to distinguish this common diagnosis from a variety of mimics. Mimics of adenomyosis include leiomyomas, uterine contractions, neoplasms, and vascular malformations. While most cases of adenomyosis develop spontaneously, there are specific inciting causes that include tamoxifen use, postendometrial ablation syndrome, and deep-infiltrating endometriosis. Other US techniques that are helpful in the diagnosis of adenomyosis include obtaining cine clips and coronal reformatted images, both of which can survey the entire endometrial-myometrial border, and performing saline-infusion sonohysterography, during which ectopic glands frequently fill with either air or fluid. Adenomyosis increases uterine vascularity, depicted as a pattern of penetrating vessels at color Doppler US. The combination of these findings results in a heterogeneous myometrium, with blurring of the endometrial border. Muscular hyperplasia and hypertrophy cause focal or diffuse myometrial thickening and globular uterine enlargement, often with thin “venetian blind” shadows. When the glands contain fluid, myometrial cysts and fluid-filled striations may be visible at US. ![]() Ectopic endometrial glands manifest as echogenic nodules and striations, radiating from the endometrium into the myometrium. US findings can be divided into three categories, which parallel the histology of adenomyosis: (a) ectopic endometrial glands and stroma, (b) muscular hyperplasia/hypertrophy, and (c) increased vascularity. Transvaginal US is now considered the primary imaging modality for the diagnosis of adenomyosis, and thus radiologists should be familiar with its sonographic appearance. Adenomyosis is a common benign uterine condition and a frequent cause of pelvic pain in premenopausal women.
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