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Case Study Of Uterine Suffering

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For women presenting with abnormal uterine bleeding with or without findings of a pelvic mass by clinical examination, differential diagnosis should include leiomyoma uteri, adenomyosis, ovarian tumors and endometrial polyps. Characterizing the pattern of uterine bleeding in association with the size and contour of the uterus, palpation of an adnexal mass and the presence of pelvic pressure, urinary and/or bowel dysfunction are important considerations when considering these other pathologies.
Pelvic pain is not a common presentation but may signify degeneration, torsion, cervical dilatation caused by a prolapsing submucous leiomyoma or the presence of concomitant adenomyosis or endometriosis. In rare instances, an insiduous onset of
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Among women in the reproductive age, the differentiation of the two is necessary , as it applies to management options and prognostication of treatment.
To differentiate between the clinical impression of leiomyoma and adenomyosis, transvaginal ultrasonography and magnetic resonance imaging may be necessary albeit dictated in favor of ultrasonography when considering availability and cost.iii On ultrasonography, a myoma is seen as a well-defined hypo- to hyperechogenic lesion surrounded by or attached to the myometrium with circumferential blood flow at the outer border. In comparison, asymmetric thickening of the myometrium, myometrial cysts, hyperechogenic islands, fan-shaped shadowing, subendometrial echogenic lines and buds (linear striation), and an irregular endometrial–myometrial junction are suggestive of adenomyosis.
Ultrasonography is the first-line test for leiomyoma. With a skilled sonologist, this easy to perform, inexpensive and readily accessible diagnostic modality can characterize, localize, measure and provide differentiating information from other diagnosis. It may allow identification of atypical leiomyoma morphology that may lead to an increased suspicion of non-benign uterine masses. Color doppler flow findings include
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