Presentation
Cyclic pelvic pain.
Patient Data
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).