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Focal adenomyosis

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Cyclic pelvic pain.

Patient Data

Age: 30 years
Gender: Female
mri

The uterus is enlarged with a focal thickening of the endometrium-myometrium junctional zone at posterior corporeal region (thickness= 38 mm), seen as an ill-defined area of intermediate signal on T1, iso-to low signal on T2 with foci of high signal (menstrual hemorrhage into the ectopic endometrial tissues), compressing the endometrial cavity which is displaced anteriorly. 

Normal ovaries.

Minimal fluid in Douglas pouch.

Case Discussion

MRI features most consistent with focal adenomyosis

On imaging, the main differential diagnosis is a uterine leiomyoma (peripheral displacement of the vessels on color Doppler +/- calcification).

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