Pregnancy with adenomyosis and leiomyoma with component of pelvic congestion

Pregnancy with adenomyosis and leiomyoma with component of pelvic congestion

• 1.
  ADENOMYOSIS MERCURYIMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH22 YEAR OLD FEMALE WITH POG OF 5WKS . EPISODIC PAIN IN THE LOWER ABDOMEN.
• 2.
  DIFFERENTIATE ADENOMYOSIS FROM LEIOMYOMA
• 3.
  FEATURES OF ADENOMYOSISEchogenecity of mass---------- HyperechoicBorders of the mass------------ill -definedVascularity 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---------- HypoechoicBorders of the mass------------DefinedVascularity of the lesion------- Peripheral Junctional zone------------------- Normal.Subendometrial / Intramyometrial cysts- Not present .
• 5.
  Present case ......................Bulky uterus with lobulated outline
• 6.
  Heterogenous pattern ofthe Myometrium
• 7.
  Intramyometrialpeneteratingvascularity.
• 8.
  Congested venoussystem.
• 9.
  Focal defined hypoechoicareas – Leiomyomas
• 10.
  G sac –5wks with ? Viability----Follow up advised . INCREASED INTRAMYOMETRIAL VASCULATURE PENETERATING PATTERN
• 11.
  CONGESTED TORTUOUS VESSELS– INTRAMYOMETRIAL . PENETERATING PATTERNFOCAL HYPOECHOIC AREAS APPRECIATED IN THE MYOMETRIUM WITH DEFINED BORDERS – CORROBORATIVE WITH SMALL LEIOMYOMA.
• 12.
  G SAC WITHNO FETAL NODE/ NO YOLK SAC. CORROBORATES WITH POG 5WKS ODAYS ......FOLLOW UP FOR VIABILITY HETEROGENOUS ECHOPATTERN OF THE MYOMETRIUM
• 13.
  MAGNIFIED VIEW OFTHE 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 ---- Tortuosvenous channels- normal response. – Pregnanacy with adenomyosis – Associated component of pelvic congestion.
• 17.
  LOW RESISTANCE ARTERIALTREE.- PREGNANT STATE WITH ASSOCIATED ADENOMYOSIS
• 18.
  ECTOPIC ENDOMETRIAL GLANDWITH SMOOTH MUSCLE HYPERPLASIA
• 19.
  LESSON LEARNTDifferentiate betweenAdenomyosis and Leiomyoma.Appreciate peneterating pattern form the Peripheral arterial tree.Differentiate focal from diffuse form of the adenomyosis.