page_title: Adenomyosis
section_title: Transvaginal ultrasonography
hierarchical_section_title: Adenomyosis / Diagnosis / Imaging / Transvaginal ultrasonography
caption_attribution_description: English: Transvaginal ultrasonography of the uterus, showing the endometrium as a hyperechoic (brighter) area in the middle, with linear striations extending upwards from it. This is a specific sign of adenomyosis.
context_page_description: Adenomyosis is a medical condition characterized by the growth of cells that build up the inside of the uterus atypically located within the cells that put up the uterine wall, as a result, thickening of the uterus occurs. As well as being misplaced in patients with this condition, endometrial tissue is completely functional. The tissue thickens, sheds and bleeds during every menstrual cycle.
  Adenomyosis can be found together with endometriosis, but patients with endometriosis present endometrial tissue abnormally located entirely outside the uterus. The two conditions are found together in many cases yet often occur separately. Before being recognized as a distinct condition, adenomyosis was called endometriosis interna. The less-commonly-used term adenomyometritis is a more specific name for the condition, specifying involvement of the uterus.
  The condition is typically found in women between the ages of 35 and 50, but also affects younger women. Patients with adenomyosis often present with painful menses, profuse menses, or both. Other possible symptoms are pain during sexual intercourse, chronic pelvic pain and irritation of the urinary bladder.
context_section_description: Transvaginal ultrasonography is a cheap and readily available imaging test that is typically used early during the evaluation of gynecologic symptoms. Ultrasound imaging, like MRI, does not use radiation and is safe for examination of the pelvis and female reproductive organs. Overall, it is estimated that transvaginal ultrasonography has a sensitivity of 79% and specificity of 85% for the detection of adenomyosis.
  Common transvaginal ultrasound findings in patients with adenomyosis include the following:
  globular, enlarged, and/or asymmetric uterus
  abnormally dense or especially varied density within the myometrium
  myometrial cysts - pockets of fluid within the smooth muscle of the uterus
  linear, acoustic shadowing without presence of a uterine fibroid
  echogenic linear striations - bright lines or stripes
  anterior/posterior wall asymmetry
  diffuse spread of small vessels within the myometrium
  Less common findings:
  Lack of contour abnormality
  Absence of mass effect
  Ill-defined margins between a normal and abnormal myometrium
  The power Doppler or Doppler ultrasonography function can be used during transvaginal ultrasonography to help differentiate adenomyomas from uterine fibroids. This is because uterine fibroids typically have blood vessels circling the fibroid's capsule. In contrast, adenomyomas are characterized by widespread blood vessels within the lesion. Doppler ultrasonography also serves to differentiate the static fluid within myometrial cysts from flowing blood within vessels.
  The junction zone (JZ), or a small distinct hormone-dependent region at the endometrial-myometrial interface, may be assessed by three-dimensional transvaginal ultrasound (3D TVUS) and MRI. Features of adenomyosis are disruption, thickening, enlargement or invasion of the junctional zone.
caption: Transvaginal ultrasound of the uterus, showing the endometrium as a hyperechoic (brighter) area in the middle, with linear striations extending upwards from it.
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