Possibility of Adenomyosis

Hi,

I was wondering if you are able to comment on some ultrasound images which were acquired trans-abdominally? Symptoms are heavy periods with clots. I'm 44  with 3 children. The endometrium seems rather bulky and I was wondering about the possibility of adenomyosis?

http://www.suremedia.com/sam/SH_ADEN13.jpg

Thanks in advance.

TJ

[Elaine Brown, MD]

Hi!
I did take a look at the image. If you were my patient, I would recommend an endometrial biopsy, as the endometrium did look quite thickened.  I would also advise you that the uterus is enlarged (normally it measures 8 cm rather than 11+).  There were no obvious fibroid tumors on the single image, which does suggest a possibility of adenomyosis.
My biggest concern would be to evaluate the endometrium!
Good luck!
Dr B

[terryjhayes]

Dear Dr. B,

Thanks so much for your helpful reply. I should probably say that the single scan image is not very representative of the true endometrial thickness as it was taken at a strange angle due to the retroverted and slightly lateral position of the uterus. Your comment obviously raised alarm bells however so I have posted some additional images which I hope you won't mind looking at. I have uploaded them as a web page to www.suremedia.com/sut

They show some better views of endometrium, myometrium heterogeneity and a pedunculated attachment which could just be left ovary but seems rather large and superficial, especially as the right ovary was barely visible trans-abdominally. It seems to sits in the midst of bowel but is not bowel.

The next step by the GP is a blood test for hormones. Would you still recommend insisting on a biopsy?

FYI - 1st day of last period was May 18.

Thanks again for all your help.