Adenomyosis Part 3 - Ultrasound Features

Take Home Points

findings we consider definitive for the diagnosis

• Myometrial cysts. These can be in the immediate subendometrial portion of the myometrium or deeper in the muscle
• Enlarged globular (gourd-shaped) uterus
  • Again, we do not call the uterus enlarged until > 12 cm in length
• Asymmetric wall thickening
• Sub-endometrial echogenic striations
• Venetian-blind shadowing emanating from the myometrium rather than a mass

what feature leads to over-diagnosing adenomyosis?

• "Heterogeneous" myometrium. This is more of a judgement call. What appears heterogeneous to some, may not to others. It is our feeling that this is the predominant cause of the increase in ultrasound diagnosis of the disease.
• While it is true that adenomyosis can lead to heterogeneity, we usually like to see at least one additional finding above before diagnosing adenomyosis.

Grading

• We generally feel that some description of the degree of adenomyosis is important.
• Again, this is a judgement call and up to individuals discretion.