0:01

Our next case is of a 24-year-old

0:02

patient who got her pelvic ultrasound

0:04

as part of an infertility workup.

0:07

At the time of this ultrasound, her LMP was

0:09

approximately three and a half weeks earlier,

0:11

which would put her in the secretory phase.

0:13

So when you're thinking about

0:14

what a normal thickness should be,

0:16

we're in the secretory phase here.

0:18

So maybe up to 18 mm or so tops.

0:21

So this is not the prettiest set of

0:23

images, but it's certainly diagnostic.

0:25

And you can see here that this

0:27

endometrium is very thick.

0:28

You can see a nice rim of myometrium around it,

0:30

but no matter how you slice it, this is

0:32

going to be far too thick at 22 mm.

0:36

So this is abnormally thickened,

0:38

but it's homogeneously thickened.

0:39

At this point, I don't see a

0:41

focal echogenic lesion, although

0:42

one certainly could be obscured.

0:45

but just rather complete diffuse thickening.

0:49

Go to the color Doppler images just

0:52

to complete your workup and make sure

0:54

we don't see any abnormal vascularity.

0:56

And again, you almost see the

0:57

endometrium a little bit better here.

0:59

What's interesting is you do see this single

1:01

feeding vessel crossing from the myometrium

1:03

here into the endometrium right here.

1:07

And then maybe if you squint a little

1:08

bit, maybe there is something a little

1:10

bit brighter right here as well.

1:12

Again, the background is thickened straight.

1:15

That's thickened no matter what, but we

1:16

may have a little polyp here as well.

1:18

I'll go backwards a little bit.

1:19

Feeding vessel to this echogenic structure.

1:21

So we have an abnormally diffusely thickened

1:24

endometrium here and probably an underlying polyp.

1:25

43 00:01:28,744 --> 00:01:31,255 Unfortunately, this ended up being

1:31

read at the time, as probably due to her

1:34

late-phase encyclical, could repeat it

1:36

after an LMP if indicated,

1:38

and she hasn't yet had repeat imaging

1:40

to prove what's going on here.

1:42

So putting this all together, this is

1:44

an abnormally thickened, homogeneously thickened

1:47

endometrial stripe and probably

1:49

represents endometrial hyperplasia.

1:51

She probably also has a polyp here on

1:54

the background of this hyperplasia.

1:56

Either way, though, she does need to

1:57

have a biopsy, and that's what you should

1:59

recommend if you see a case like this.