Abnormally thickened endometrium (differential)
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Abnormally thickened endometrium on imaging may occur for a number of reasons which may be categorised based on whether or not they are related to pregnancy. Aetiologies may also be classified based on whether the patient is premenopausal or postmenopausal.
Differential diagnosis
Pregnancy-related
- early pregnancy: prior to sac being visualized (<5 weeks of gestation)
- ectopic pregnancy: thickened endometrium and sometimes fluid collection or pseudogestational sac can be associated
-
retained products of conception
- heterogeneously thickened endometrium, with increased vascularity
-
there canmay be fluid collection(s) -
thesefindings are usually associated with an enlarged uterus
-
intra-uterineintrauterine blood clot: heterogeneous endometrium with no vascularity - molar pregnancy: thickened with multiple small cystic spaces
- recent gestational state (delivery)
Non-pregnancy related
- endometrial carcinoma: variable appearance
- endometrial hyperplasia: usually uniformly hyperechoic and tends to be diffuse. Can be a differential diagnosis of many conditions i.e. PCOS
- endometrial polyp: usually hyperechoic, often focal, look for vascular stalk
- Tamoxifen-related endometrial changes: variable appearances
- hormone replacement therapy (HRT): in postmenopausal female
-
endometritis: prominent hyperechoic endometrium
with or without+/- fluid and debris - adhesions: irregular echogenic areas with focal thickening
- obstructed outlet
- ovarian tumours associated with endometrial thickening
Practical points
- endometrial thickness in the secretory phase (days 14-28) may normally be up to 12-16 mm (see: endometrial thickness)
- non-emergent ultrasounds are optimally evaluated at day 5-10 of the menstrual cycle to reduce the wide variation in endometrial thickness
- the thickest portion of the endometrium should be measured
- if there is fluid in the uterine cavity, it should be excluded from the measurement, which would be the sum of the two sagittal plane thicknesses
- ~10% of endometrial carcinoma occurs in premenopausal women
See also
-<li>there can be fluid collection(s)</li>-<li>these findings are usually associated with an <a href="/articles/uterine-enlargement-differential">enlarged uterus</a>- +<li>may be fluid collection(s)</li>
- +<li>findings are usually associated with an <a href="/articles/uterine-enlargement-differential">enlarged uterus</a>
-<a href="/articles/intrauterine-blood-clot-1">intra-uterine blood clot</a>: heterogeneous endometrium with no vascularity</li>- +<a href="/articles/intrauterine-blood-clot-1">intrauterine blood clot</a>: heterogeneous endometrium with no vascularity</li>
-<a href="/articles/tamoxifen-associated-endometrial-changes">Tamoxifen-related endometrial changes</a>: variable appearances</li>- +<a href="/articles/tamoxifen-associated-endometrial-changes-1">Tamoxifen-related endometrial changes</a>: variable appearances</li>
-<a href="/articles/endometritis">endometritis</a>: prominent hyperechoic endometrium with or without fluid and debris</li>- +<a href="/articles/endometritis">endometritis</a>: prominent hyperechoic endometrium +/- fluid and debris</li>