Endometrial sonography
Normal endometrium
Premenopausal Endometrium
• During menstruation---- a thin echogenic line,
1–4 mm in thickness
• In early proliferative phase of the menstrual
cycle(after day 6) becomes thicker (5–7 mm)
and more echogenic relative to the
myometrium, (glands, blood vessels, and
stroma)
• Late proliferative (periovulatory) phase
• a multilayered appearance.
• an echogenic basal layer and hypoechoic inner
functional layer, separated by a thin echogenic
median layer.
• may measure up to 11 mm in thickness.
• During the secretory phase, becomes even
thicker (7–16 mm) and more echogenic .
• stromal edema and glands distended with
mucus and glycogen.
• increased posterior acoustic enhancement.
• The endometrium typically reaches a
maximum thickness during the mid secretory
phase
On Ultrasound
• Endometrial thickness is measured from
echogenic border to echogenic border across
the endometrial cavity on a sagittal midline
image.
Postmenopausal Endometrium
• should be thin, homogeneous, and echogenic.
• Homogeneous, smooth endometria
measuring 5 mm or less are considered within
the normal range with or without hormonal
replacement therapy.
Endometrial Polyps
• a common cause of postmenopausal bleeding
• most frequently seen in patients receiving tamoxifen or
HRT.
• may be broad-based and sessile or pedunculated.
• Typically measure 5-15mm.
• The point of attachment should not disrupt the
endometrial lining.
Ultrasonographic appearance
• frequently identified as focal masses within
the endometrial canal.
• as nonspecific endometrial thickening.
• Color Doppler US may be used to image
vessels within the stalk
Sonohysterogram reveals a small polyp attached by a stalk to the
endometrium.
Endometrial polyp.
Multiple endometrial polyp.
• Endometrial fibroids are hypoechoic, well
demonstrated in echogenic endometrium of
secretory phase and have peripheral
vascularity, typical of fibroids
Endometrial hyperplasia
• an abnormal proliferation of endometrial
stroma and glands
• represents a spectrum of endometrial changes
ranging from glandular atypia to frank
neoplasia
Causes
• Polycystic ovaries
• Obesity
• Exogenous hormones
• Endogenous excess estrogen production
Ultrasonographic appearance
Endometrial hyperplasia is considered
• when the endometrium exceeds 10 mm in
thickness, especially in menopausal patients
• In postmenopausal women 5mm thickness is
significant.
Endometrial hyperplasia. US image shows an endometrium with diffuse
thickening (maximum thickness, 1.74 cm) due to hyperplasia. This finding
was confirmed at biopsy.
Endometritis
• Acute endometritis presents as thick,
isoechoic endometrium with disruption of
junctional zone
• minimal fluid in endometrial cavity and
increased vascularity, even in early follicular
phase.
Synechiae
• When the endometrium is triple line or the
cavity is distended with the fluid, synechiae
are seen as lines bridging between layers of
endometrium
• Other endometrial lesions are postcurettage
endometrial collection, vesicular mole, missed
abortion, incomplete abortion, etc.
• These are all avascular and show
heterogeneous echogenicity. Clinical history
guides to the diagnosis
• Vesicular mole shows a thick echogenic
endometrium with small anechoic areas
snowstorm appearance.
• This echogenicity is higher than that of a
normal secretory endometrium as it is
because of decidual reaction.
• If it becomes malignant, it would break the
endometriomyometrial interface