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Myometrial Disorders Myometrium Echogenicity

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Myometrial Disorders Myometrium Echogenicity Myometrial Disorders Myometrium Echogenicity Mani Montazemi, RDMS Director of Ultrasound Education & Quality Assurancee Baylor College of Medicine Division of Maternal-Fetal Medicine Texas Children’s Hospital, Pavilion for Women Houston Texas & Clinical Instructor Thomas Jefferson University Hospital - Radiology Department Normal myometrium has a smooth even texture throughoutut Philadelphia, Pennsylvania Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Inhomogeneous Myometrium Myometrium Echogenicity ••TransientTransient ••RealReal 2 min later 5 min later Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Myometrium Echogenicity Myometrium Echogenicity S R A •Arcuate artery •Radial artery •Spiral artery Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Inhomogeneous Myometrium Focal Densities Sub-Endometrial ••DensitiesDensities Placental site nodule ––Small,Small, focal, well defined Myometrium Fibroid, Scar, IUD ••LucenciesorLucencies or holes ––VesselsVessels ––flow flow Outer myometrium Arcuate Calcification ––CystsCysts ––no no flow ••MassesMasses ––DiscreteDiscrete with a border ––fibroid fibroid ––Ill-definedIll-defined ––adenomyosis adenomyosis Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Endo/Subendometrial Densities Placental Site Nodules ••FocalFocal echodensityechodensityat at endo-myo junctionjunction ••ProbablyProbably persistent site of prior implantationimplantation ••FoundFound in women with at least 1 pregnancy ••AA benign microscopic lesion of intermediateintermediate trophoblasttrophoblast ––NoNo reports of GTD or malignancy ––Microscopically:Microscopically: well-well-circumscribed circumscribed nodulesnodules Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Endo/Subendometrial Densities Endo/Subendometrial Densities ••MostMost are variants of normal ••MostMost are clinically insignificant Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Myometrium Densities Myometrium Densities Transabdominal Transvaginal Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Myometrium Densities Myometrium Densities Normal Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders 43 y/o G0P0 Outer Myometrium intermenstrual bleed + pain Arcuate Artery Calcifications ••MayMay be seen in older women as symmetric calcified punctate structures ••AssociatedAssociated with ––DiabetesDiabetes ––HypertensionHypertension Right arm extends into the myometrium Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Diagnostic Challenge Uterine Leiomyoma – US Findings ••DiscreteDiscrete solid mass ––singlesingle oror multiplemultiple •Variable•Variable echogenecityechogenecity –Hypoechoic,–Hypoechoic, hyperechoic,hyperechoic, isoechoicisoechoic •Sound-attenuating•Sound-attenuating •Contour-deforming•Contour-deforming •Can•Can distortdistort thethe endometrialendometrial canalcanal Mani Montazemi, RDMS Myometrium Disorders Uterine Leiomyoma – US Findings Uterine Leiomyoma – US Findings •Discrete•Discrete solidsolid massmass •Discrete•Discrete solidsolid massmass –single–single oror multiplemultiple –single–single oror multiplemultiple ••VariableVariable echogenecity •Variable•Variable echogenecityechogenecity ––Hypoechoic,Hypoechoic, hyperechoic, –Hypoechoic,–Hypoechoic, hyperechoic,hyperechoic, isoechoicisoechoic isoechoicisoechoic •Sound-attenuating•Sound-attenuating ••Sound-attenuatingSound-attenuating •Contour-deforming•Contour-deforming •Contour-deforming•Contour-deforming •Can•Can distortdistort thethe endometrialendometrial •Can•Can distortdistort thethe endometrialendometrial canalcanal canalcanal Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Uterine Leiomyoma – US Findings Uterine Leiomyoma – US Findings •Discrete•Discrete solidsolid massmass •Discrete•Discrete solidsolid massmass –single–single oror multiplemultiple –single–single oror multiplemultiple •Variable•Variable echogenecityechogenecity •Variable•Variable echogenecityechogenecity –Hypoechoic,–Hypoechoic, hyperechoic,hyperechoic, –Hypoechoic,–Hypoechoic, hyperechoic,hyperechoic, isoechoicisoechoic isoechoicisoechoic •Sound-attenuating•Sound-attenuating •Sound-attenuating•Sound-attenuating ••Contour-deformingContour-deforming •Contour-deforming•Contour-deforming •Can•Can distortdistort thethe endometrialendometrial ••CanCan distort the endometrial canal canalcanal •May•May undergoundergo fattyfatty degeneration, calcification, hemorrhage, and necrosis Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Atypical Uterine Fibroids Atypical Uterine Fibroids ••NecrosisNecrosis ••CysticCystic degeneration • Calcification •Calcification Broad Ligament Pedunculated ••FattyFatty degeneration ••InfectionInfection ••SarcomatousdegenerationSarcomatous degeneration Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Atypical Uterine Fibroids Ovarian Carcinoma Metastases to Uterus Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Calcified Uterine Fibroids Uterine Fibroids If large leiomyoma is located near the cervix, vaginal delivery may be difficult or impossible Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders subserosal intramural Leiomyoma Locations ••SubmucosalSubmucosal ••SubserosalSubserosal ••IntramuralIntramural --95% 95% pedunculated submucosal ••PedunculatedPedunculated ••CervixCervix --3% 3% ••BroadBroad ligament Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Submucosal Fibroids Submucosal Fibroids ••IncompletelyIncompletely surroundedsurrounded Problem? by endometrium ••AcousticAcoustic shadowing Bleeding may be due to ••EchogenicendometriumEchogenic endometrium vascular engorgement or ––secretoryphasesecretory phase erosion of the overlying endometrial membrane Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Submucosal Fibroids Submucosal or Intramural Fibroids may effect fertility by obstructing the movement of sperm or inhibiting normal implantation Diffuse Blood Flow Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Submucosal Fibroids Pedunculated Submucosal Fibroid Associated with reproductive dysfunction ••HypoechoicmassHypoechoic mass that is completely endoluminal including:including: with a narrow base of ••RecurrentRecurrent miscarriages attachment ••EndometriumEndometrium covering ••PrematurePremature labor thethe fibroidfibroid isis thickenedthickened ••FetalFetal malpresentations & irregular ––ChronicChronic edema or ••ComplicationsComplications of labor inflammationinflammation relatedrelated toto irritationirritation fromfrom thethe massmass Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Intramural Leiomyoma Intramural Fibroids may distort the endometrial canal may displace the endometrial canal Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Intramural Fibroids may displace the endometrial canal Subserosal Fibroids Will distort the uterine contour and may be difficult to distinguish from adnexal masses when pedunculated Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Diagnostic Challenge Diagnostic Challenge “probe” with the probe ! moves with uterus “probe” with the probe ! moves with uterus Color ! blood supply from uterus Mani Montazemi, RDMS Mani Montazemi, RDMS Identify separate ovary Myometrium Disorders Myometrium Disorders Uterine Fibroids Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Uterine Fibroids RLQ Pain Post Partum ••AsAs cause of acute pelvic pain: ––InfarctionInfarction (usually associated with pregnancy) ••outout grow blood supply ––resulting resulting in ischemia ••nono longer support of blood supply then the vessels involuteinvolute quickly quickly ––TorsionTorsion Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Acute Hemorrhagic RLQ Pain Post Partum Infarction of Fibroid Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Uterine Fibroids Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Pedunculated Fibroids UT Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Fatty Tumors of the Uterus Lipoleiomyoma ••Rare,Rare, benign tumor of myometrium that contains fat ••AsymptomaticAsymptomatic ••HighlyHighly echogenic, solid myometrial mass that attenuates soundsound (diagnostic)(diagnostic) ••VariableVariable mixtures of fat, smooth muscle, fibrous tissue ••CT,CT, MRI to confirm fat Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Lipoleiomyoma vs. Cystic Teratoma Diagnostic Challenge Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Diagnostic Challenge Leiomyosarcoma ••AccountsAccounts for only 1-3% of uterine malignancies ••BelievedBelieved to arise from existing leiomyomas ••IndistinguishableIndistinguishable from leiomyomaleiomyoma Mani Montazemi, RDMS Mani Montazemi, RDMS Myometrium Disorders Myometrium Disorders Leiomyosarcoma Premenopausal
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