1. ADENOMYOSIS MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH 22 YEAR OLD FEMALE WITH POG OF 5WKS . EPISODIC PAIN IN THE LOWER ABDOMEN.

2. DIFFERENTIATE ADENOMYOSIS FROM LEIOMYOMA

3. FEATURES OF ADENOMYOSIS Echogenecity of mass---------- Hyperechoic Borders of the mass------------ill -defined Vascularity of the lesion------- Penetrating Size of uterus---------------------Bulky with asymmetrical lobulations ( anterior and posetrior). Junctional zone-------------------Thick. ( >8mm ( 8-12mm) >12mm) ( MR sagittal plane T2w sequence gives best assesment of junctional zone) Subendometrial / Intramyometrial cysts -Present .

4. FEATURES OF LEIOMYOMA Echogenecity of mass---------- Hypoechoic Borders of the mass------------Defined Vascularity of the lesion------- Peripheral Junctional zone------------------- Normal. Subendometrial / Intramyometrial cysts- Not present .

6. Heterogenous pattern of the Myometrium

7. Intramyometrialpeneteratingvascularity.

8. Congested venous system.

9. Focal defined hypoechoic areas – Leiomyomas

11. CONGESTED TORTUOUS VESSELS – INTRAMYOMETRIAL . PENETERATING PATTERN FOCAL HYPOECHOIC AREAS APPRECIATED IN THE MYOMETRIUM WITH DEFINED BORDERS – CORROBORATIVE WITH SMALL LEIOMYOMA.

12. G SAC WITH NO FETAL NODE/ NO YOLK SAC. CORROBORATES WITH POG 5WKS ODAYS ......FOLLOW UP FOR VIABILITY HETEROGENOUS ECHOPATTERN OF THE MYOMETRIUM

13. MAGNIFIED VIEW OF THE G SAC SINGLE LINER ADENOMYOSIS CAN PREDISPOSE TO INTRAMYOMETRIAL ECTOPIC PREGNANCY

14. BULKY UTERUS WITH LOBULATED OUTLINE

15. PENETERATING PATTERN OF THE VASCULATURE

16. VALSALVAE ---- Tortuos venous channels- normal response. – Pregnanacy with adenomyosis – Associated component of pelvic congestion.

17. LOW RESISTANCE ARTERIAL TREE.- PREGNANT STATE WITH ASSOCIATED ADENOMYOSIS

18. ECTOPIC ENDOMETRIAL GLAND WITH SMOOTH MUSCLE HYPERPLASIA

19. LESSON LEARNT Differentiate between Adenomyosis and Leiomyoma. Appreciate peneterating pattern form the Peripheral arterial tree. Differentiate focal from diffuse form of the adenomyosis.