King’s Gynaecology Ultrasound
Uterine Pathology
Rehan Salim MD MRCOG
King’s Gynaecology Ultrasound
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
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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
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Duplication anomalies
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Duplication anomalies
King’s Gynaecology Ultrasound
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
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Three-dimensional ultrasound
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Diagnosis of uterine anomalies
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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
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Uterine fibroids
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Fibroids• Size• Number• Location
– Submucous– Intramural– Subserous– Pedunculated
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Mapping of fibroids
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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
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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
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Submucous fibroid
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Submucous fibroid
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Submucous fibroid
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Submucous fibroid
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Adenomyosis
• Endometrial glands within myometrium• Benign• Associated with pain and menorrhagia• Present in 20% of hysterectomy specimens
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Adenomyosis
• Asymmetrical thickening of myometrium• Hyperechogenic• Cystic• Acoustic shadowing• Diffuse branching vessels
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Adenomyosis
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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.
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Intrauterine adhesions
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Osseous metaplasia
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Caesarean section scars
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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