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Evaluating Endometrial Thickness With Ultrasound Part II

September 11, 2009
Written by: , Filed in: Obstetric Ultrasound
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In Part I we looked at evaluating endometrial thickness in premenopausal woman. In Part II,  we will look at evaluating endometrial thickness with ultrasound  in further detail.

Evaluating Endometrial Thickness in Postmenopausal Women

For post-menopausal endometrium there are some differing opinions,  but generally I think that most authors would agree, or most examiners would agree, that up to 8 mm in a post menopausal woman who is not bleeding is normal. This is not a bleeding patient. And in fact, some radiologists would say up to 11 mm is normal.

If the woman is bleeding, then I would say that 5 mm is the upper limit of normal. Some radiologists will say 4 mm is the upper limit of normal.

Now this is not normal endometrium for post menopausal women. That endometrium is atrophic. It is abnormal endometrium, and that is why the patient is bleeding, because her endometrium is atrophic. The importance being that if you sample this endometrium with a Pipelle, you get back insufficient tissue for diagnosis. So the gynecologist doesn’t know where they stand.

So it is very valuable, when you do a sonogram, you identify atrophic endometrium, endometrium under 5 mm or under 4 mm, and even though that’s a pathologic diagnosis, it means that the patient almost certainly does not have endometrial carcinoma.

With endometrial carcinoma, you’re still using that 5 mm cut-off, but quite often, it’s a really horrendous looking thing. You will see this gigantic mass inside of the patient’s uterus which constitutes the endometrial carcinoma.

You will also want to pay close attention to focal thickenings of the endometrium. So here we have very thin endometrium but all of a sudden it becomes focally thickened. These are either usually and most commonly endometrial polyps, but occasionally they are submucous myomas.

Submucous myomas shadow, endometrial polyps do not.

Submucous myomas have multiple vessels that feed them, while endometrial polyps have single vessels.

What you do want to ask for this in this instance is a sonohysterogram, so that you can identify the lesion as a focal abnormality, identify its location in the uterus and the size of its base. When you see that lesion hysteroscopically it will give you a much better image of the lesion.

Author: Roy A. Filly, MD
Excerpted from:
Diagnostic Imaging Review: For Residents, Fellows and Radiologists
Female Pelvis Section

Women’s and Breast Imaging

New York University Post-Graduate Medical School and the Department of Radiology This course is designed for the practicing radiologist with particular interest in women’s imaging and breast imaging. During the women’s imaging segment, the participating faculty will discuss each of the imaging modalities applied to obstetrical and gynecological imaging including ultrasound, MRI and CT. Practical and multimodality approaches to common imaging problems in the female pelvis will be emphasized, including imaging of the patient with pelvic pain, evaluation of adnexal masses and assessment of benign and malignant disorders of the uterus. Topics in obstetrical imaging will include requirements for the sonographic fetal anatomic survey, sonographic evaluation of obstetrical emergencies, normal and abnormal first trimester pregnancy and imaging pitfalls. The role of MR and CT in the evaluation of the pregnant patient will also be discussed. Click here to read more or order: Women’s and Breast Imaging
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One Response to “Evaluating Endometrial Thickness With Ultrasound Part II”

  1. Nico on June 21st, 2012 at 10:44 am

    I am on the other side of the microscope (pathologist) and usually when endometrium is called thick or given a double figure measurement on ultrasound, it is almost the rule to find very little atrophic endometrium on the slide or less than 1mm in a hysterectomy specimen. What could be the explanation of this.

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