radiology basics of myoma endometriosis

1. Uterine Myoma, Endometriosis,
Endometrial Ca and Cervical CA
on Ultrasound
Abel Girma (RR)

2. Myomas:
▪ Uterine leiomyomas, also known as uterine fibroids.
▪ ~25% of women of reproductive age and over 70% of women by
menopause.
▪ Commonly Incidental
▪ Dx is rarely difficult

3. Typical Sonographic Features
▪ Round
▪ Heterogenous
▪ Hypoechoic
▪ Sound attenuating
▪ Contour Deforming
▪ Often calcified
▪ Usually Multiple

4. Intramural Myoma
• Surrounded By Myometrium
• Often have a submucosal or Subserosal
component
• Describe the amount of each component
• To Plan surgical approach

5. Transmural Myoma : From Serosa to submucosa

6. Submucous Myoma
▪ Surrounded by endometrium
▪ Surface area of the myoma that is surrounded by endometrium
should be described
▪ Associated with reproductive Problems
▪ Prone to torsion if they are Pedunculated

7. Myoma Prolapsing through Cervix

8. Location of Myoma : SHG

9. Location of Myoma : SHG

10. Subserosal Myoma

11. Subserosal Pedunculated Myoma
▪ The Pedicle diameter < 50 % of the Myoma
▪ May not be seenTransvaginally

12. Secondary Changes in Myomas
▪ Degeneration : Hyaline, Calcific, Cystic, Fatty, Red, Sarcomatous
▪ Necrosis
▪ Hemorrhage
▪ Infection

14. Adenomyoma vs Leiomyoma

15. Endometrial CA
▪ considered the most common gynecological malignancy. It
frequently presents with vaginal bleeding.
▪ peak incidence at around the 6th decade, though 12% of cases
present in premenopausal women.
▪ risk factors for endometrial carcinoma are anything that leads to
increased estrogen exposure

16. Ultrasound Features
▪ Endometrial carcinoma usually appears as thickening of the endometrium
though may appear as a polypoid mass.
▪ premenopausal: normal endometrial thickness varies through the
menstrual cycle
▪ diagnosing abnormally thickened endometrium depends on knowing what
the patient's point in the menstrual cycle
▪ postmenopausal: >5 mm is thickened (>8 mm if on hormone replacement
therapy or tamoxifen)
▪ Sonographic features are non-specific and endometrial thickening can also
be due to benign proliferation, endometrial hyperplasia, or polyps.

17. Endometrial Thickness

18. Ultrasound features that are suggestive of
endometrial carcinoma rather than hyperplasia include
▪ heterogeneous and irregular endometrial thickening
▪ polypoid mass lesion
▪ intrauterine fluid collection
▪ frank myometrial invasion
– Disruption of a subendometrial halo on ultrasound may be
suggestive of myometrial involvement

19. Endometrial Adenocarcinoma

20. SHG

21. Endometriosis…
▪ Endometriosis is a common multifocal gynecologic disease that
manifests during the reproductive years, often causing chronic pelvic
pain and infertility.
▪ Endometriosis is a chronic gynecologic disorder that is characterized
by the growth of endometrial tissue outside the uterine cavity,
primarily as implants in the pelvic peritoneum and ovaries ,
▪ Ovarian lesions are characterized by cysts with hemorrhagic content.

22. Drawings of the female pelvic anatomy in the axial (a) and sagittal (b) planes show the
locations of multiple endometriotic lesions.The round black lesion in the right ovary in a
represents an endometrioma.The lesions with irregular margins are indicative of deeply
infiltrating endometriosis

23. Trans vaginal Ultrasound after Bowel Preparation:
▪ Bowel preparation is used to eliminate fecal content and gas in the
rectosigmoid colon.
▪ It includes a mild laxative administered in two oral doses (at 8:00 am
and 2:00 pm) the day before the scheduled transvaginal US
examination, a low-residue diet for 24 hours before the examination.

24. Dynamic Scanning…
▪ Pelvic adhesions can be evaluated by gently moving the
transducer back and forth against the cervix during
abdominal palpation to assess whether the uterus, ovaries,
and bowel loops slide freely over each other

25. Limitations of Transvaginal US
▪ The main limitation of transvaginal US is the restricted field of view. It is difficult to
visualize lesions located outside the pelvis.
▪ Other common conditions that may impair lesion visualization are large ovarian
cysts, subserosal leiomyomas, and acute retroflexion of the uterus.
▪ In addition, severe pelvic adhesions and other distortions of the pelvic anatomy
may limit transvaginal US evaluation of the pelvic region.

26. Bladder endometriosis in a 28-year-old woman.
▪ (a) Sagittal transvaginal US image shows a hypoechoic nodule (N)
attached to the bladder wall and hypoechoic endometrial tissue
infiltrating the detrusor muscle (arrow).
▪ (b) Magnified cystoscopic view of the same lesion (arrows) shows
bluish spots (*) that represent tiny hemorrhagic foci.

27. Endometriosis of the anterior pelvic compartment in a
32-year-old woman
(a) Sagittal oblique transvaginal US image shows a hypoechoic endometriotic lesion (arrowheads) with
irregular and ill-defined margins that has infiltrated the peritoneum near the insertion of the left
round ligament.
(b) (b) Laparoscopic view depicts vesicouterine peritoneal infiltration (arrows) near the left round
ligament (LRL).

28. Paracervical endometriosis with ureteral stenosis in
a 35-year-old woman with infertility.
(a, b) Sagittal oblique transvaginal US images show a large
heterogeneous paracervical mass (ovoid dotted line)
representative of an endometriotic lesion that has surrounded
the dilated left ureter (arrowheads).The lesion is best depicted
in a, and the ureteral dilatation, in b.
(c)Transabdominal US image of the left kidney demonstrates
moderate hydronephrosis.

29. Endometrioma
Transvaginal US image obtained in a 26-year-old woman with pelvic pain
shows an endometrioma with a hyperechoic peripheral nodule (arrow) in the right ovary.
Transvaginal US image obtained in a 28-year-old woman shows an endometrioma with a fluid-fluid
level (arrow) in the left ovary.
The lighter area to the left of the arrow represents more recent hemorrhage, a finding made more
recognizable by the sepia colorization.

30. Cervical CA
▪ Reading Assignment

31. Thank You