Fact-sheet: Adenomyosis - Internal endometriosis
Updated on 08/13/2020 at 2:07 PM
Note : 0/10
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Definition
Invagination of the endometrial glandular mucosa within the myometrium.
This is associated with cystic dilation and then reactive hypertrophy of the myometrium.
Common condition, multiparous women (35-50 years), endocavitary procedures (curettage).
Frequently associated with deep endometriosis.
Clinical features
- Menometrorrhagia
- Dysmenorrhea
- Pelvic pain
- Risk of infertility
Ultrasound
- Globular and irregular uterus
Asymmetric walls < muscular hypertrophy - Comb-like appearance (US reverberation related to endometrial glands)
Myometrium:
- Thickening of the junctional zone
- Round cystic endometrial glands, intramyometrial, anechoic, without Doppler flow
- Linear vascularity traversing the myometrium
Adenomyoma
- Rounded lesion, located within the myometrium, anechoic content
- Doppler: straight traversing vessels
MRI
It is performed in cases of diagnostic uncertainty:
- Round images in the junctional zone (visible in a woman of reproductive age, in the inner third of the myometrium)
(T2 hyperintense, T1 hypointense: fluid content - +/- T1 hyperintense if hemorrhagic content)
- Thickening of the junctional zone > 12 mm (on 2 T2 sequences in different planes)
Special cases:
- Simple adenomyoma:
Focal, nodular myometrial thickening with T2 hypointensity, sometimes T2 hyperintense spots (difficult differential diagnosis with a fibroid) - Hemorrhagic cystic adenomyoma or adenomyotic cyst:
Hemorrhage within an ectopic glandular focus. Fluid with T1 FatSat hyperintensity + T2 hypointense rim
Differential diagnosis
- Uterine contraction during the examination
- Uterine fibroid (in this case Doppler will show peripheral vascularity)
