ULTRASOUND EVALUATION OF ADENOMYOSIS AND ITS ASSOCIATIONWITH ABNORMAL UTERINE BLEEDING
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Keywords
adenomyosis, abnormal uterine bleeding, transvaginal ultrasound, sonography, myometrium, dysmenorrhea, histopathology
Abstract
Background: Adenomyosis is a benign uterine disorder characterized by ectopic endometrial glands and stroma within the myometrium and is commonly associated with heavy menstrual bleeding, dysmenorrhea, chronic pelvic pain and subfertility. Transvaginal ultrasound (TVUS) is widely used for diagnosis because it is accessible, dynamic and capable of assessing characteristic myometrial changes.
Aim: To evaluate the sonographic features of adenomyosis and determine their association with abnormal uterine bleeding (AUB) in a 100-woman cohort.
Methods: One hundred women presenting with AUB were evaluated by standardized TVUS. Symptoms, uterine size and sonographic features including globular uterine configuration, myometrial heterogeneity, fan-shaped shadowing, myometrial cysts, hyperechoic islands, echogenic subendometrial lines/buds, junctional-zone abnormality, uterine wall asymmetry and vascularity were recorded. Histopathology was reviewed where uterine tissue was available. Descriptive statistics and cross-tabulation were used.
Results: Mean age was 41.2 ± 6.8 years. Heavy menstrual bleeding was present in 68%, dysmenorrhea in 61% and chronic pelvic pain in 32%. Adenomyosis was sonographically suspected in 72%. The commonest ultrasound features were heterogeneous myometrium (64%), globular uterus (58%), fan-shaped shadowing (51%), hyperechoic islands (42%) and myometrial cysts (39%). Histopathology was available in 52 cases and confirmed adenomyosis in 42 (80.8%).
Conclusion: Standardized TVUS demonstrates a useful constellation of features for identifying adenomyosis in women with AUB. Combining multiple direct and indirect signs is preferable to relying on a single feature. Clinical and pathological correlation strengthens diagnostic confidence.
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