Adenomyosis

This is a relatively common condition that affects women of reproductive age and is considered to be a variant of endometriosis. The histologic diagnosis of adenomyosis is made when endometrial glands and stroma are seen within the myometrium. It is found to coexist with  endometriosis in up to 20% of women. Adenomyosis typically presents in women who are in the latter part of their reproductive years and multiparous. The classic presenting symptoms are dysmenorrhea and menorrhagia. The disease is more common in women who have had previous uterine surgery, most commonly dilatation and curettage and cesarean section. On clinical examination, the uterus might be enlarged, especially on the posterior uterine wall, where adenomyosis is usually more extensive.

The ultrasound diagnosis of adenomyosis is problematic because there are no characteristic features. In most cases, the uterus appears normal or enlarged, and the posterior uterine wall might appear thickened. The myometrium can appear heterogenous with areas of both hyperechogenicity and hypoechogenicity representing areas of small myometrial cysts. These cysts contain the remnants of menstrual flow from the ectopic endometrium.

An adenomyoma is a focal, localized area of endometriosis and might be distinguishable as a focal echo-poor mass. However, the appearances can be very similar to a uterine fibroid, which might be a coexistent pathology.