Figure-28-18b. Punctuate calcifica tions at the endometrial myometrial inte rface in a patient with two prior dilatation and curettage procedures Intrauterine Contraception Devices Another cause of bright refectors within the uterus are intrauterine contraception deices(IUDs)(Fig. 28-19A and Fig. 28-19B) Ultrasound is helpful in locating an IUD when the string cannot be fe lt. The iUd should be located centrally within the endometrium. a straight shaft iud givesa bright linear reflectorwith entrance-exit refections and ring-down artifacts (23) The Lippes loop IUd also has a characteristic appearance with segmental reflectors with shadowing(see Fig.28-19B) 18/16 Intrauterine contraception devices(IUDs). Straight shaft IUD. Figure-28-19b. Lippes loop IUD. If the IUD is not visualized sonographically, radiogra phs should be obta ined to exclude an extrauterine location of an IUD Abnormal Endometrium Thick Endometrium Causes of a thickened endometrium indude the nomal secretory phase endometrium, endometrial hyperplasia, endometrial polyps, f braids, endometritis, early pregnancy, and complications of pregnancy. These are listed in (Table 28-13) Secretory Endometrium In women of menstrual age, the upper limitof nomal endometrial thickness is 14 to 16 mm. However, the endometrium can be thicker than this in the secretory phase and still be normal. An asymptomatic woman who is in the secretory phase by menstrual history, with a homogeneously echogenic thickened endometrium
Figure - 28-18b. Punctuate calcifications at the endometrial myometrial interface in a patient with two prior dilatation and curettage procedures. Intrauterine Contraception Devices Another cause of bright reflectors within the uterus are intrauterine contraception devices (IUDs) (Fig. 28-19A and Fig. 28-19B ) . Ultrasound is helpful in locating an IUD when the string cannot be felt. The IUD should be located centrally within the endometrium. A straight shaft IUD gives a bright linear reflector with entrance-exit reflections and ring-down artifacts. (23) The Lippes loop IUD also has a characteristic appearance with segmental reflectors with shadowing (see Fig. 28-19B ). Figure - 28-19a. Intrauterine contraception devices (IUDs). Straight shaft IUD. Figure - 28-19b. Lippes loop IUD. If the IUD is not visualized sonographically, radiographs should be obtained to exclude an extrauterine location of an IUD. Abnormal Endometrium Thick Endometrium Causes of a thickened endometrium include the normal secretory phase endometrium, endometrial hyperplasia, endometrial polyps, fibroids, endometritis, early pregnancy, and complications of pregnancy. These are listed in (Table 28-13 ) . Secretory Endometrium In women of menstrual age, the upper limit of normal endometrial thickness is 14 to 16 mm. However, the endometrium can be thicker than this in the secretory phase and still be normal. An asymptomatic woman who is in the secretory phase by menstrual history, with a homogeneously echogenic thickened endometrium
with posterior ustic enhancement, probably needs no follow-up(see Fig. 28-5B) If any atypical features are seen, a follow-upexamination after menstruation Figure-28-5 ecretory phase endometrium that is thick and echogenicwith posterior acoustic enhancement Fibroids Submucosal fibroids also give the appearance of a thick endometrium caused by the distortion of the endometrial-myometrial interface. Endometritis Endometritis occurs in association with pelvic inflammatory disease(PID)and in postpartum patients. The endometrium appears prominent or irregular with a small amountof endometrial fluid (24, 25) Gas bubbles can be present; however, these are also a nomal postpartum finding (26) Synechiae Synechiae rarely are visualized in the nongravid uterus. They are found in women with a historyof sponta neous abortion or ut erine curettage. Vag inal sonography may demonstrate bright echoes within the endometrial cavity in this condition(27) Endometrial Hyperplasia, Polyps, and Cancer As women approach menopause, the inddence of endometrial hyperplasia, polyps, and cancer increase as causes of endometrial thickening( Fg. 28-20A, Fig 28-20B, and Fig. 28-20C ). Endometrial hyperplasia is caused by unopposed estrogen; the endometrium is thickened either diffusely or focally(see Fig. 28-13A and Fig. 28-18A) Endometrial polyps usually are asymptomatic but may cause uterine bleeding. Theyalso cause diffuse or focal endometrial thickening (24)(see Fig. 28-3B and Fig. 28-20B). In both of these conditions (endometrial hyperplasia and polyps), the interface between the endometrium and the myometrium is Utility of endometrial fluid in outlining endometrial abnomalities is demonstrated. Sonohysterography catheter(arrows)is seen entering the endometrial cavty Fluid outlines a well-defined intracavitary mass
with posterior acoustic enhancement, probably needs no follow-up (see Fig. 28-5B ). If any atypical features are seen, a follow-up examination after menstruation is helpful. Figure - 28-5b. Secretory phase endometrium that is thick and echogenic with posterior acoustic enhancement Fibroids Submucosal fibroids also give the appearance of a thick endometrium caused by the distortion of the endometrial -myometrial interface. Endometritis Endometritis occurs in association with pelvic inflammatory disease (PID) and in postpartum patients. The endometrium appears prominent or irregular with a small amount of endometrial fluid. (24,25) Gas bubbles can be present; however, these are also a normal postpartum finding. (26) Synechiae Synechiae rarely are visualized in the nongravid uterus. They are found in women with a history of spontaneous abortion or ut erine curettage. Vaginal sonography may demonstrate bright echoes within the endometrial cavity in this condition. (27) Endometrial Hyperplasia, Polyps, and Cancer As women approach menopause, the incidence of endometrial hyperplasia, polyps, and cancer increase as causes of endometrial thickening ( Fig. 28-20A , Fig. 28-20B , and Fig. 28-20C ). Endometrial hyperplasia is caused by unopposed estrogen; the endometrium is thickened either diffusely or focally (see Fig. 28-13A and Fig. 28-18A ). Endometrial polyps usually are asymptomatic but may cause uterine bleeding. They also cause diffuse or focal endometrial thickening (24) (see Fig. 28-3B and Fig. 28-20B ). In both of these conditions (endometrial hyperplasia and polyps), the interface between the endometrium and the myometrium is preserved. Figure - 28-20a. Utility of endometrial fluid in outlining endometrial abnormalities is demonstrated. Sonohysterography catheter (arrows) is seen entering the endometrial cavity. Fluid outlines a well -defined intracavitary mass