In this talk we will discuss three common endometrial pathologies, namely, endometrial polyps, endometrial hyperplasia and endometrial carcinoma. These can all cause abnormal uterine bleeding and often present as a thickened endometrium on ultrasound, making their diagnosis challenging at times.
We will initially focus on what measurement of the endometrium defines it as a ëthickenedí endometrium. In post-menopausal women a thickness of 5 mm or more would be considered a thickened endometrium, however, in premenopausal women, it is difficult to assign a cut off.
Though the final diagnosis is histopathological, there are various ultrasound features that help differentiate between these three conditions, enabling their proper management. Benign polyps are usually hyperechoic and well defined. If they fill the entire endometrial cavity they may look like thickened endometrium. Heterogeneous endometrial tissue and the presence of intracavitory fluid raises the possibility of endometrial carcinoma. A vascular pattern with a single feeder vessel in polyps, multifocal scattered linear vessels crossing the EMJ (endomyometrial junction) in endometrial hyperplasia, and randomly dispersed vessels that do not originate from the EMJ in endometrial carcinoma, often help in their differentiation.
In addition to discussing the grey scale and Doppler features, this talk will also cover other techniques like sonohysterography, 3D Doppler and subtle findings that will further enhance the diagnostic accuracy in patients with a thickened endometrium.