Uterine Pathology

King’s Gynaecology Ultrasound

Uterine Pathology

Rehan Salim MD MRCOG


Congenital uterine anomalies

• Associated with poor reproductive histories– Recurrent first trimester miscarriage

• Relatively rare– 3% in “normal” women– 3% infertile women– 6-24% in recurrent miscarriage

• Several types – most common “duplication anomalies”– Arcuate, subseptate, bicornuate


Congenital uterine anomalies• Ultrasound first line screening tool• Accurate in screening for duplication anomalies

– Split in endometrial echo by “septum”– Conventional ultrasound not able to differentiate

further• Accurate in detecting more severe anomalies

– Unicornuate- single interstitial portion of Fallopian tube

– Rudimentary cornu may be present +/- functioning endometrium


Duplication anomalies


Congenital uterine anomalies

• Three-dimensional ultrasound– Non-invasive accurate method for evaluation of

uterine morphology– Examination of organ from all aspects– Measurements of organs’ volume regardless of their

shape– 3-D reconstruction of pelvic anatomy


Three-dimensional ultrasound


Diagnosis of uterine anomalies


Fibroids

• Focal proliferation of uterine smooth muscle• Benign • Associated with menstrual disorders, subfertility, pain,

pressure symptoms• Common

– 40% of women aged 40 will have at least one fibroid


Uterine fibroids


Fibroids• Size• Number• Location

– Submucous– Intramural– Subserous– Pedunculated


Mapping of fibroids


Assessment of submucous fibroids

• Proportion of submucous uterine fibroid protruding into the uterine cavity is critical for successful surgical removal

• Classification of submucous fibroids prior to surgery is difficult• 3-D SIS is a novel technique for assessing the uterine cavity, which

has potential advantages over 2-D SIS and diagnostic hysteroscopy


Classification of submucous fibroids

• Type 0 - pedunculated fibroid without intramural extension

• Type I - sessile fibroid with intramural extension <50%

• Type II - sessile with an intramural extension >50%

The European Society of Hysteroscopy, 1993


Submucous fibroid


Adenomyosis

• Endometrial glands within myometrium• Benign• Associated with pain and menorrhagia• Present in 20% of hysterectomy specimens


Adenomyosis

• Asymmetrical thickening of myometrium• Hyperechogenic• Cystic• Acoustic shadowing• Diffuse branching vessels


Adenomyosis


Intrauterine adhesions

• The uterine cavity is irregular and hyperechogenic. • Calcifications are often present causing shadowing on

the scan.• Areas of normal endometrium may be preserved.• Echogenic intrauterine fluid accumulation may be

present suggestive of haematometra.


Intrauterine adhesions


Osseous metaplasia


Caesarean section scars


Ultrasound of the uterus

• Sensitive method to diagnose a variety of uterine abnormalities

• Saline infusion sonohysterography improves sensitivity and specificity of the diagnosis of intracavitary lesions

• 3-D ultrasound is the method of choice for the diagnosis of congenital uterine anomalies

• 3-D SIS has a potential to become a standard technique for pre-operative assessment of submucous fibroids

Uterine Pathology

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