What is your diagnosis?
Clearly we are dealing with a significant pathology in the uterus, producing relatively echogenic and inhomogenous, poorly defined lesions in the posterior myometrium. These lesions do not appear to have mass effects, unlike uterine myomas/ fibroids. There are also relatively large cystic lesions in the myometrium close to the junctional zone or endo-myometrial junction. There appears to be an infiltration of the endometrium into the myometrium in the fundus of the uterus, producing the false appearance of thickening of the endometrium, in this region. What kind of disease can produce these ultrasound findings in the uterus? Clearly, these appearances are seen in only one condition- adenomyosis of the uterus. In addition, the marked hyperemia of the diseased areas is also consistent with adenomyosis.
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