Presentation
Four-day history of crampy suprapubic and right lower quadrant abdominal pain. Presenting with vaginal bleeding of one pad per hour. Past medical history is significant for menorrhagia.
Patient Data
The uterus is anteverted. The myometrium is diffusely heterogeneous/coarse in echotexture, with increased vascularity, and demonstrates numerous regions of acoustic shadowing.
The endometrial stripe is thickened measuring up to 1.5 cm, irregularly shaped, and hyperemic.
Case Discussion
This is a case of adenomyosis demonstrating the classic “Venetian blind” appearance.
The patient had been following up with gynecology for clinical suspicion of endometriosis given her symptoms. She was started on estrogen-containing oral contraceptives (which is likely the etiology of the thickened endometrium).
On physical exam, there was mild abdominal tenderness, a normal-appearing cervix with bright red blood in the vaginal vault, and an absence of adnexal or cervical motion tenderness. The patient was not hemorrhaging and the rate of bleeding was appropriate for discharge home. A follow-up MRI (not shown) corroborated the findings of adenomyosis.
Co-author:
Ciara Dobrowolski
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