0:01

Okay, and case four that we have here is a

0:04

kind of bring it all together case where it

0:05

has lots of different findings in adenomyosis.

0:08

So this is one of those entities where

0:10

you can have, you know, one of the

0:11

findings, you can have two of the findings,

0:13

or you can have all of the findings.

0:14

So this is one where it has a

0:15

lot of different findings here.

0:17

So we're going to just start

0:18

with some still images here.

0:20

The uterus itself, a little bit globular here,

0:23

with a fundus.

0:24

And already endometrium, really hard to say what

0:26

it is, is just this very thin stripe right here.

0:28

Is it this whole larger structure right here?

0:31

And then you see these echogenic nodules already

0:33

emanating and a poor interface right there.

0:35

So already we're thinking

0:37

this person has adenomyosis.

0:39

Keep scanning through a bit.

0:41

Again, now you have a

0:42

myometrial cyst right here.

0:44

It almost looks like endometrium

0:45

is really extending out here.

0:47

It's really hard to tell exactly where the

0:48

endometrium ends again, where it should

0:51

be versus where it is in the myometrium.

0:54

Now we have some color Doppler flow.

0:56

We have, again, this penetrating

0:57

appearance of the vessels as opposed to

1:00

a fibroid right here and more echogenic

1:02

emanating striations heading out.

1:04

We have our nodules here again as well.

1:06

So we have a little bit of everything

1:08

on this particular patient.

1:10

We go through our cine clips

1:14

just again to show you those

1:15

striations of echogenic nodules.

1:18

little cysts, the poor interface.

1:22

She's got all of the findings pretty much of

1:25

adenomyosis minus the Venetian blind sign.

1:28

That's pretty much the only one we

1:29

don't have in her particular case.

1:33

One more image here of the endometrial

1:34

stripe in a slightly different view.

1:37

She actually ended up having a little bit

1:38

of everything, not just adenomyosis, but she

1:41

did have a well-defined fibroid right here.

1:42

And again, the difference here between this

1:44

case and some of the other cases, you can see

1:47

exactly where that fibroid stops and where

1:49

the regular myometrium begins right here.

1:51

So it probably has a

1:52

submucosal component as well.

1:54

It has a very different appearance than

1:57

the adenomyosis that we've seen otherwise.

1:59

Other things you might notice as you're

2:01

scrolling through this case on your

2:02

own is that there's a focal echogenic

2:04

structure within the endometrium.

2:05

So she actually ended up having a polyp as well.

2:08

So she really did have a little bit

2:10

of everything in this particular case.

2:14

So if we go back to the still images

2:15

and look at the 3D, remembering this

2:17

is a retroverted retroflexed uterus, so

2:19

everything's going to be flipped upside down.

2:21

You can see beautifully her

2:23

endometrium right here, right?

2:24

We see a little divot right here and right here.

2:27

One of those is probably going to be

2:28

from that fibroid we saw right there.

2:30

And you can also look for those

2:32

little emanations coming out.

2:34

If you look really closely, again,

2:35

I wouldn't use this to decide it.

2:37

I think it's better seen on the grayscale,

2:38

but you can see some little striations

2:40

that are coming out in different locations.

2:42

Again, that's the endometrium

2:43

extending out into the myometrium.

2:46

Here we zoom in a little bit more.

2:47

I think you can see them a little bit better.

2:49

There's kind of nodules right

2:50

here and just kind of confirms it.

2:52

Fibroid right here with a submucosal

2:53

component, more striations

2:55

and nodules over here as well.

2:58

So you can see it on 3D

2:59

if you're looking for it.