junctional zone, genitourinary tract, genitourinary system, uterus, woman, Art in Anatomy, Ashley Davidoff MD, adenomyosis, ultrasound

Ultrasound of the Uterus With Endometriotic Disease in the Junctional Layer

Two echogenic nodules (overlaid in green in image on the right) are present  in the subendometrial layer, (junctional zone) of the uterus in a woman with menorrhagia. The nodules are in close proximity and  have appositional relationships with the endometrial stripe (yellow overlay). They distort the endometrial lining. These findings likely  account for the menorrhagia.  Included in the differential diagnosis are dystrophic changes in prior foci of adenomyosis and submucosal fibroids.  An MRI would assist to characterize  the lesions in the subendometrial layer.

The junctional zone is hypoechoic  due to decreased water content, and is formed by smooth muscle cells that are tightly packed.  The extracellular matrix and water content are sparse.  It usually measures less than 8mm. In this case the thickness is normal.

Description

Two echogenic nodules (overlaid in green in image on the right) are present  in the subendometrial layer, (junctional zone) in a woman with menorrhagia. The nodules are in close proximity and  have appositional relationships with the endometrial stripe (yellow overlay). They distort the endometrial lining. These findings likely  account for the menorrhagia.  Included in the differential diagnosis are dystrophic changes in prior foci of adenomyosis and submucosal fibroids.  An MRI would assist to characterize  the lesions in the subendometrial layer.

The junctional zone is hypoechoic  due to decreased water content, and is formed by smooth muscle cells that are tightly packed.  The extracellular matrix and water content are sparse.  It usually measures less than 8mm. In this case the thickness is normal.