World Hysteroscopy Forum

25/04/2025

Sonographic features of adenomyosis :

A heterogeneous myometrium.
Myometrial cysts.
Globular uterine enlargement, greater than 12 cm in length.
An asymmetrical anteroposterior myometrium, with the anterior wall appearing thinner than the posterior wall.
An endometrial junction that is difficult to identify.
A thickened transitional zone. (When the hypoechoic layer surrounding the endometrium measures greater than 12 mm, it is strongly associated with adenomyosis.)
Subendometrial echogenic linear striations.
MRI uses the features and measurements of the junctional zone to determine the extent of adenomyosis, while 2D ultrasound focuses on the heterogeneity of the myometrium. 3D ultrasound provides significantly more information about the junctional zone.

The Ultrasound in Obstetrics and Gynecology study notes that myometrial cysts are the most specific 2D ultrasound feature when diagnosing adenomyosis, while the most sensitive feature is a heterogeneous myometrium. The major advantage provided by 3D ultrasound, besides the added view of the coronal plane, is its ability to reveal the degree of junctional zone infiltration and distortion .

01/04/2025

T‐shaped dysmorphic uterus diagnosis using 3D ultrasound :
Combination of key measurements
* lateral bulging (LB ≥ 5 mm)
* fundal/isthmic cavity width ratioR0/Wi≥ 5
* intracavitary line (R10 ≤ 10 mm)
greatly improves diagnostic accuracy when at least two are met.
This objective approach can help standardize diagnosis and guide better treatment decisions for reproductive health.

19/03/2025

Indian Head Dress Sign in Deep Infiltrating Endometriosis
The "Indian headdress sign" on transvaginal ultrasound (TVS) in deep infiltrating endometriosis (DIE) refers to hypoechoic, irregular structures resembling an "Indian headdress" or "moose antler" due to endometriotic deposits causing retraction and adhesions in the re**um.

Here's a more detailed explanation:

What it is:

The "Indian headdress sign" appears on TVS as hypoechoic (darker) areas with irregular shapes, often with thin, band-like echoes radiating outwards, resembling an Indian headdress or moose antlers.

What causes it:

This sign is a result of endometriotic tissue infiltrating the bowel wall, causing retraction and adhesion of the muscularis propria, which is the normal muscular layer of the re**um.

Why it's important:

The "Indian headdress sign" is a valuable indicator of deep endometriosis, particularly in the rectosigmoid area, and can help guide further diagnosis and treatment.

Other names:

This sign is also sometimes referred to as the "moose antler sign".

How it's seen:

During a transvaginal ultrasound (TVS), the bowel wall lesions appear as hypoechoic (darker) and solid, focal, and tubular with slightly irregular margins. In some cases, a thinner section or a "tail" may be noted at one end, resembling a "comet".

Other signs of deep endometriosis:

Other sonographic features of deep endometriosis include obliteration of the pouch of Douglas, a negative "sliding sign" (where the re**um and uterus do not slide freely against each other), and hypoechoic nodules in the rectovaginal septum.

Diagnosis:

While TVS is a valuable tool for detecting deep endometriosis, the gold standard for diagnosis remains visual inspection by laparoscopy, preferably with histological confirmation.

08/03/2025

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25/01/2025

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