DOI: 10.1148/rg.233025150
US of Abnormal Uterine Bleeding1
Penny L. Williams, MD,
Sherelle L. Laifer-Narin, MD and
Nagesh Ragavendra, MD
1 From the Department of Radiological Sciences, University of California, Los Angeles, Center for the Health Sciences. Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received October 7, 2002; revision requested October 31 and received December 16; accepted December 16. Address correspondence to P.L.W., 10964 Wellworth Ave #102, Los Angeles, CA 90024 (e-mail: pennalee@hotmail.com).
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Figure 1. US image shows apposition of the anterior and posterior endometrial walls with central echogenicity of the endometrial echo complex.
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Figure 2. Transverse US image of a patient with end-stage liver disease shows an abnormally thickened endometrium.
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Figure 3. Transverse US image of a hyperstimulated ovary shows multiple enlarged follicles up to 3 cm in diameter, some of which contain debris, which is consistent with hemorrhage.
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Figure 4. Longitudinal US image shows multiple follicles (more than eight) less than or equal to 5 mm in diameter, an appearance consistent with polycystic ovarian disease.
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Figure 5. Sagittal US image of the uterus shows a linear echogenic structure (arrow) in the lower uterine segment, an appearance consistent with a low-lying IUD.
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Figure 6. Sagittal US image of the left ovary shows a cystic mass with diffuse low-level internal echoes, an appearance consistent with an endometrioma.
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Figure 7. Sagittal US image shows a multiloculated mass with fluid-debris levels, which was initially thought to be a tubo-ovarian abscess. A surgical specimen demonstrated endometriomas.
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Figure 8. Transverse US image shows an enlarged, globular, diffusely heterogeneous uterus, an appearance consistent with adenomyosis.
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Figure 9. Longitudinal transabdominal US image shows an enlarged uterus with multiple ill-defined leiomyomas.
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Figure 10. Sagittal US image shows a solid, slightly heterogeneous mass in a subserosal, exophytic location (arrow), an appearance consistent with a pedunculated leiomyoma.
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Figure 11. Longitudinal US image of the left adnexa shows a round mass with internal low-level echoes. Pathologic analysis demonstrated an exophytic degenerating leiomyoma.
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Figure 12. Longitudinal US image shows multiple echogenic foci throughout the uterine fundus with "dirty" shadowing posteriorly, an appearance consistent with air bubbles. The patient recently underwent embolization for a uterine leiomyoma.
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Figure 13. Sagittal US image of a 90-year-old patient shows fluid and debris (arrow) distending the endometrial cavity. Dilation and curettage demonstrated pyometrium.
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Figure 14. Sagittal US image shows a serpentine tubular structure with low-level echoes in the right adnexa, an appearance consistent with pyosalpinx.
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Figure 15. Sagittal US image shows an anechoic serpentine tubular structure in the right adnexa, an appearance consistent with hydrosalpinx.
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Figure 16. Sagittal US image shows a complex mass in the right adnexa that contains cystic components with internal debris, a solid component, and multiple septa. The mass represented a tubo-ovarian abscess.
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Figure 17. Sagittal US image of a patient who underwent hysterectomy shows a large, heterogeneous, midline mass. The mass appears cystic and contains echogenic foci that produce ring-down artifact, which likely represent gas. Pathologic analysis demonstrated squamous cell carcinoma of the cervix.
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Figure 18. Sagittal US image of the uterus shows a tiny (3-mm-diameter) fluid collection (arrow) in a patient with a positive pregnancy test. The fluid collection was confirmed to be a 4.7-week intrauterine pregnancy.
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Figure 19. Coronal US image of the uterus shows an eccentrically located gestational sac containing a yolk sac in the right cornual region (arrow). There is a thin (2-mm) myometrial mantle.
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Figure 20a. Transverse (a) and longitudinal (b) US images of the cervix show a gestational sac (arrow) containing a yolk sac and a live embryo.
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Figure 20b. Transverse (a) and longitudinal (b) US images of the cervix show a gestational sac (arrow) containing a yolk sac and a live embryo.
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Figure 21. Sagittal US image of the left adnexa shows an echogenic focus within the peritoneum (arrow) caudal to the left ovary (OV). The patient has an intrauterine pregnancy, and her IUD could not be located at clinical examination. A corresponding coronal US image showed a linear echogenic structure in the peritoneum, which was consistent with an IUD that had perforated the myometrium.
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Figure 22. Coronal US image shows an echogenic ring (arrow), which is consistent with an ectopic gestational sac containing a yolk sac and demonstrated cardiac activity. Complex fluid, consistent with hemoperitoneum, surrounds the structure.
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Figure 23. Sagittal US image of the right adnexa shows a ring-shaped structure (arrow) containing a gestational sac and yolk sac. Cardiac activity was present.
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Figure 24a. (a) Sagittal US image shows fetal demise in the uterine fundus (arrow). (b) Longitudinal US image obtained the next day shows the gestational sac in the lower uterine segment (arrow), an appearance consistent with an abortion in progress.
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Figure 24b. (a) Sagittal US image shows fetal demise in the uterine fundus (arrow). (b) Longitudinal US image obtained the next day shows the gestational sac in the lower uterine segment (arrow), an appearance consistent with an abortion in progress.
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Figure 25. Coronal US image shows a 10-week gestational sac with a 9.1-week-old fetus. No blood flow or heart motion was detectable.
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Figure 26. Coronal US image shows a large, crescentic, subchorionic hypoechoic area (arrow), which is consistent with hemorrhage.
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Figure 27. Transverse US image shows a large, subchorionic area of hemorrhage in an anterior location (arrow).
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Figure 28. Longitudinal US image shows that the placenta has a posterior location and completely covers the internal cervical os.
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Figure 29. US image shows posterior placenta previa with vessels crossing the cervical os.
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Figure 30a. Coronal (a) and sagittal (b) US images show an irregular mass with multiple cystic spaces that fills the uterine cavity, an appearance consistent with a hydatidiform mole.
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Figure 30b. Coronal (a) and sagittal (b) US images show an irregular mass with multiple cystic spaces that fills the uterine cavity, an appearance consistent with a hydatidiform mole.
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Figure 31a. Gray-scale (a) and color (b) transverse US images show a complex solid and cystic mass (arrow) in a portion of the endometrial cavity that extends into the anterior myometrium.
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Figure 31b. Gray-scale (a) and color (b) transverse US images show a complex solid and cystic mass (arrow) in a portion of the endometrial cavity that extends into the anterior myometrium.
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Figure 32. Coronal US image of the endometrial echo complex shows a thickened, heterogeneous endometrium with multiple cystic components (arrow), an appearance consistent with hydropic placental degeneration.
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Figure 33. Longitudinal US image of the cervix shows membranes and a fetal lower extremity in the vagina. This appearance is consistent with cervical incompetence, as the patient was not having contractions.
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Figure 34. Longitudinal US image of the lower uterine segment shows bulging membranes. This appearance is consistent with cervical incompetence, as the patient was not in labor.
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Figure 35. Longitudinal US image of the cervix shows a shortened cervical length (2.8 cm) and a dilated os, an appearance consistent with cervical incompetence.
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Figure 36. Sagittal US image of a patient with a 25-week intrauterine pregnancy who presented to the emergency department with contractions. The cervix (CX) is dilated and a fetal lower extremity and membranes bulge into the vaginal canal (VAG), an appearance consistent with preterm labor.
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Figure 37. Sagittal US image of the uterus obtained 3 days after childbirth shows echogenic foci producing ring-down artifact in the lower uterine segment (arrow), an appearance consistent with gas in the endometrial cavity.
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Figure 38. Sagittal US image of the uterus shows a heterogeneously thickened endometrium. Low-resistance arterial flow is present. Pathologic analysis demonstrated retained products of conception.
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Figure 39. Coronal US image of the uterus after menopause shows a thin (3-mm) endometrial echo complex (arrow).
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Figure 40. Longitudinal US image of the uterus in a postmenopausal patient shows a markedly thickened, heterogeneous endometrium with cystic spaces, which is suggestive of hyperplasia or a polyp. Pathologic analysis demonstrated a polyp.
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Figure 41a. (a) Transverse US image of the uterus shows a markedly thickened, heterogeneous endometrial echo complex (arrow). (b) Transverse image from saline hysterosonography shows multiple endometrial polyps (arrow).
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Figure 41b. (a) Transverse US image of the uterus shows a markedly thickened, heterogeneous endometrial echo complex (arrow). (b) Transverse image from saline hysterosonography shows multiple endometrial polyps (arrow).
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Figure 42. Longitudinal image from saline hysterosonography shows a freely mobile, 3-cm-diameter endometrial polyp on a long stalk (arrow) without increased vascularity.
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Figure 43a. (a) Transverse US image of a patient being treated for breast carcinoma shows that the endometrium is thickened and heterogeneous, containing multiple tiny cystic spaces. (b) Transverse image from saline hysterosonography shows a large tamoxifen-induced polyp.
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Figure 43b. (a) Transverse US image of a patient being treated for breast carcinoma shows that the endometrium is thickened and heterogeneous, containing multiple tiny cystic spaces. (b) Transverse image from saline hysterosonography shows a large tamoxifen-induced polyp.
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Figure 44. Sagittal US image of a 76-year-old patient shows marked irregular thickening of the endometrium. Pathologic analysis demonstrated endometrial carcinoma.
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Copyright © 2003 by the Radiological Society of North America.
