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The first case is of a 57-year-old female who's

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postmenopausal for approximately five years.

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We'll start here with her

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sagittal uterus cine clip.

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I find in the diagnosis of adenomyosis,

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the sagittal is just indispensable.

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This is what I use to diagnose it.

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So just scrolling through

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once, the uterus is slightly small.

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Again, she's postmenopausal five,

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five years, so that makes sense.

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We'll stop sort of centrally here.

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Where exactly would you

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measure this endometrium?

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Now here, maybe you have a nice good

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interface right here where the endometrium

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ends, the myometrium starts, but in other

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places it's really hard to tell if it's at

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the end here, maybe over here, way up here.

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And that's because we've lost that interface.

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The other things that we're seeing here, we're

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seeing these echogenic like striations like

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emanating out from the endometrium down here.

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We're also seeing these nodules right here,

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right here, these echogenic nodules, more

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nodules right here, and these are not in the

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endometrium, they're in the myometrium adjacent.

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More nodules here, striations here,

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striations here, so in this case, you can

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actually maybe see the junctional zone.

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I said, you don't often see it with ultrasound,

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but I can certainly imagine this is probably

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a thickened junctional zone right here.

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And again, these striations and echogenic nodules,

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which are the same sort of

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echogenicity of the endometrium itself.

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Those are the ectopic endometrial glands

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emanating out into the myometrium right there.

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And in this case, our sonographer was

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practicing with the 3D right here.

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It's not the most beautiful image right here.

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We have, you know, vague fundal contour

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right here, endometrium right here,

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and you can see all these little bright spots.

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One of the reasons why this didn't turn out

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really nicely is because you see all of these

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bright spots emanating out from the endometrium

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here, because that is ectopic endometrial

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tissue extending out into the myometrium.

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So this is a pretty classic example of

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adenomyosis, where you get the loss of

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the interface between the endometrium and

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myometrium, and you see these emanating

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striations and echogenic nodules into the

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myometrium from the endometrium there.

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This is classic adenomyosis.