Diagnostic ultrasound ( PDFDrive )

532 PART II Abdominal and Pelvic Sonography
A B C
D
E
F
G
FIG. 15.3 Endometrium—Normal Appearances. All images were obtained with sagittal TVS. (A) Normal thin endometrium that may be seen
in the menstrual phase or very early proliferative phase. A similar appearance is normal in postmenopausal women. (B) Normal thin endometrium
with trace luid (arrow) in the endometrial cavity in the menstrual phase. (C) Multilayered, also known as “triple-layered” or “trilaminar” (or sandwich
sign), appearance typical of the mid to late proliferative phase. (D) In the secretory phase, the endometrium begins to become hyperechoic, usually
beginning at the outer edge (arrows) and progressing inward. (E) As the endometrium becomes hyperechoic in the secretory phase, it sometimes
does so in an irregular fashion, which can simulate polyps. These have been referred to as endometrial moguls or pseudopolyps (arrows). Repeat
scanning in the proliferative phase of the menstrual cycle can be helpful in such cases. (F) Uniformly hyperechoic appearance of the endometrium
in the late secretory phase. (G) Normal thin postmenopausal endometrium, in this case measuring 2 mm in thickness.
with real-time gray-scale imaging, perhaps with increased gain
settings, will usually show the movement of echoes in these
veins with slow low, conirming their vascular nature. Small
calciications may be present in the outer myometrium (Fig. 15.5),
thought to be in arcuate arteries, and are most commonly seen
in postmenopausal women. 45,46 Although it has been suggested
that these calciications might be more common in women with
systemic diseases such as diabetes mellitus and renal failure, the
literature thus far describes only a small number of patients. 13,45,46
he peripheral location and difuse linear nature of these vascular
calciications should help distinguish them from calciied
ibroids.