Case report: management of cystic adenomyosis

Diagnosis on TVS scan by the following distinctive featuresAsymmetrical myometrial thickening, parallel shadowing, myometrial cysts, hyperechoic islands, irregular endo-myometrial junction.On 3D USG, junctional zone-thickening and disruption in adenomyosis, under normal circumstances it is hypoechoeic, heterogenous myometrial echotexture, increased echogenicity or linear striation due to ectopic endometrial tissue and presence of Subendometrial cysts.MRI criteria -thickness of Junctional zone >12mm, broadening of JZ is infiltrative (normal <5mm).High T2 signal intensity linear striations radiating out of the endometrium.1,2 Distinctive features of differentiation from fibroid are as in chart below FIBROIDS ADENOMYOSIS Defined margins Poorly defined margins Round shape Variable shape Mass effect No mass effect Calcifications No calcification Attenuation with edge shadowing Multiple foci of attenuation Peripheral vascularization Rectilinear vascularization JZ intact Variable thickening of JZ General examination was normalPositive findings on TVS-Transverse dimensions were increased.Presence of 2 intramural subendometrial cysts of 1cm and 0.8cm