Radiological Reasoning: Algorithmic Workup of Abnormal Vaginal Bleeding with Endovaginal Sonography and Sonohysterography

Ann A Shi, Susanna I Lee
AJR. American journal of roentgenology · 2008 · vol. 191(6_supplement) , pp. S68–S73 · doi:10.2214/ajr.07.7067 · PMID:19018052 · W2120891152
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This paper presents cases illustrating an algorithmic approach to abnormal vaginal bleeding using endovaginal sonography and sonohysterography to identify endometrial pathologies like fibroids, adenomyosis, polyps, and hyperplasia.

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Abstract

OBJECTIVE: The workup of endometrial abnormalities can be a confusing task for radiologists because one must take into account the patient's clinical history, imaging findings, and a wide array of diagnostic options. We present two cases, one of a premenopausal woman presenting with vaginal bleeding and another of a postmenopausal woman taking tamoxifen who has abnormal findings on endovaginal sonography. The evaluations of these patients serve to illustrate the diagnostic algorithm for identification of endometrial pathology. CONCLUSION: Imaging plays a central role in the algorithm for detection of endometrial disorders in women with abnormal vaginal bleeding. Endovaginal sonography is used to identify mural abnormalities such as fibroids and adenomyosis and to screen for thickened endometria that require nonfocal biopsy for the diagnosis of cancer or hyperplasia. Sonohysterography serves as a triage tool to detect focal abnormalities of the endometrial cavity, such as endometrial polyps or subendometrial fibroids, thereby identifying those women who require more invasive workup with hysteroscopy.

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Condition tags

adenomyosis

MeSH descriptors

Algorithms Decision Support Systems, Clinical Ultrasonography Uterine Hemorrhage Vagina Vaginal Diseases Adult Aged Female Humans Ultrasonography Uterine Hemorrhage Vagina Vaginal Diseases

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References (28)

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chemicals 1
tamoxifen

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