What are benign tumors of the uterus. Anechogenic formation in the uterus: concept, diagnosis and treatment What formations can be in the uterus

Benign neoplasms of the uterus rank first among all tumors of the female reproductive system and most often affect women of childbearing age from 20 to 35 years.

According to statistics, every 4 women in the world are diagnosed with uterine fibroids. One of the main problems is the difficulty of conception and even infertility, as well as the high risk of threatened abortion when pregnancy occurs.

Despite the fact that the tumor is benign, some types of fibroids have a high risk of malignancy or degeneration into a malignant tumor.

Myoma is a variant of a benign tumor with a histological structure originating from the muscular layer of the uterus - myometrium. The most common histological type among all benign forms.

It has a nodal structure, the boundaries between atypical tissues and healthy ones are clearly defined. There are 3 types of myomatous nodes, they all differ in shape and growth.

Submucosal or submucosal growth variant. For this variant of myomas, the germination of the myometrium up to a third with the growth of the tumor into the uterine cavity is characteristic. Outwardly, the fibroid looks like a volumetric formation covered with endometrium, having a so-called nutritional stalk and a wide or narrow base.

Tumor sizes can vary widely. The submucosal type of fibroids most often undergoes malignancy and has a rapid growth rate.

Interstitial or intramural option. In this case, the myomatous node is located in the thickness of the muscle layer - the myometrium. Fibroids can grow in more than two-thirds of the muscle layer.
Subserous or subperitoneal variant. The tumor is located between the myometrium and the parametrium or pelvic peritoneum. Growth is exophytic, i.e. strives out. Subserous fibroids, as well as submucous ones, most often form a myomatous node on a stalk with a base.

A typical complication of fibroids is persistent bleeding, leading to the development of anemic syndrome or even hypovolemia. In addition to bleeding, with high tumor mobility, the birth of a myomatous node can occur.

In more than half of the cases, the myomatous node does not manifest itself in any way, i.e. the course of the process is asymptomatic, subject to the slow growth of fibroids.

With an increase in its size, symptoms such as acyclic bleeding from the external genitalia, discomfort and pain with large fibroids begin to form.

Infertility or habitual miscarriage can also become a symptom characteristic of fibroids. If the tumor is very large, it can be felt, and in some cases it is well visualized, as the abdomen increases in volume.

The reasons

The cause of myomatous nodes may be a hormonal imbalance of female sex hormones, with a predominance of the estrogen pool.

Estrogens contribute to the growth of the myometrium and its hyperplasia, however, it should be noted that factors such as a chronic inflammatory process localized in the small pelvis and adverse environmental factors play an equally important role in this case.

Fibroma

Uterine fibroma is the second most common histological form among all benign tumors. Fibroma belongs to the so-called type of mature tumors, as it has a relatively high degree of tissue differentiation.

Histologically, the tumor has a structure with a large percentage of connective tissue and grows in the form of nodular formations with a clear contour. As well as in fibroids, with fibroids There are three main forms of tumor growth:

Submucosal or submucosal form on a stalk with a base;
Intramural or interstitial form located in the center of the myometrium. The interstitial form of uterine fibroids is the most common;
Subserous form with subperitoneal location of the node.

A feature of the structure and development of fibroids is a high risk of torsion and bending of the leg., which leads to malnutrition in the fibrous node. The tumor has a slow growth rate and because of this, symptoms are practically not observed.

Fibroma can be complicated by such diseases as: hydronephrosis and pyelonephritis, constipation, bending of the leg of the fibromatous node, as a rule, Fibroma does not bleed.

Symptoms and clinical picture

Fibroma detection becomes a diagnostic finding during routine examinations. However, in a small percentage of cases with large tumor volumes and trophic disorders in it, a woman may experience severe sharp pains localized in the lower abdomen, which is typical for fibroma malnutrition.

A voluminous fibromatous node can exert pressure on neighboring organs, which leads to the formation of discomfort and a feeling of heaviness in the lower abdomen. As a result of bladder compression, a woman may notice an increase in urination, while she does not have any diseases from the urinary system.

The reasons

Uterine fibroids, like fibroids, have a hormone-dependent mechanism of formation. Frequent diagnostic manipulations in the uterine cavity, chronic endometritis, a history of abortions, and an unfavorable social background lead to an increased risk of fibroma formation.

Often, progressive growth in the size of the fibroma receives during the development of pregnancy in a woman. This also confirms the hormone-dependent pathogenetic mechanism of development.

You can see what the tumor looks like in this video, which demonstrates the entire removal process:

fibromyoma

Another common form of benign tumor of the uterus. Most often, fibromyoma develops from the muscle tissue of the myometrium, its essential component is connective tissue.

The percentage of connective and muscle tissue in the tumor can vary significantly in each individual case. A characteristic feature for the formation of such a tumor is a mature age from 35 to 45 years, regression of a benign neoplasm in the postmenopausal period.

Like other benign tumors of the uterus, fibromyoma has three main growth options: with submucosal, intramural, subserous localization.

Fibroids are characterized by the same complications as uterine fibroids: heavy bleeding with anemic syndrome.

Symptoms and clinical picture

Despite slow growth, fibromyoma is often accompanied by menorrhagia, i.e. profuse bleeding during menstruation, also there may be spotting outside the cycle. The pain does not have a high intensity, but occurs in most women.

The reasons

The cause of development is hormonal imbalance, often in women with fibromyoma, polycystic ovary syndrome is detected. This form can develop with frequent inflammatory diseases of the internal genital organs and improper use of combined oral contraceptives.

The opinion of specialists about this type of tumor, as well as a visual demonstration of the models of the disease, in this video:

Leiomyoma

A benign tumor of the uterus of a muscular structure, has a low degree of cellular differentiation of tissues. It occurs in late reproductive age in women from 35 to 45 years. It has a nodal structure and three growth options: submucosal, interstitial and subserous.

Complications of leiomyoma are associated with impaired functioning of neighboring organs, i.e. hydronephrosis of the kidneys and persistent constipation.

Symptoms and clinical picture

The tumor grows slowly and does not have bright symptoms. Symptoms appear only with a significant volume of the tumor, when it begins to compress neighboring organs. With a large leiomyoma, symptoms such as constipation and frequent urination occur. At very large sizes, urination can be difficult.

The reasons

The reasons for the development are the same hormonal imbalance in combination with chronic inflammatory diseases of the endometrium and harmful environmental factors.

Here is what a leiomyoma looks like:

Diagnostic methods

Ultrasound diagnostics is the gold standard for detecting neoplasms of the uterine body. Can be performed with a transabdominal or transvaginal probe. When conducting an ultrasound examination, each tumor variant will have differences in the echo picture:

Myoma- a heterogeneous hypoechoic structured formation of a round or oval shape with clear contours.
Fibroma- a formation of different sizes with a hyperechoic heterogeneous structure, on ultrasound it looks like a heterogeneous light formation.
fibromyoma- combines the above features and has areas with hypo and hyperechoic structure.
Leiomyoma- hyperechoic formation with a homogeneous structure due to low differentiation of cellular elements.

Also on ultrasound, in addition to the structure and size, it is possible to determine the variant of tumor growth.

To clarify the localization, shape and number of nodes, it is possible to conduct magnetic resonance imaging. MRI diagnostics allows you to study in detail the structure of the tumor and its shape, up to the assessment of vascular blood flow in the area of the nodule. An MRI can determine whether there is an area with necrotic changes in the tumor.

Treatment

Treatment always begins with expectant management. Monitoring the development and progression of a uterine tumor lasts up to 10-12 weeks, thus expectant management is important for neoplasms ranging in size from 2 cm to 8-10 cm.

If a woman is diagnosed with fibromyoma at premenopausal age, then the observation can be extended, since the tumor can undergo regression on its own.

Drug therapy consists in the use of various hormonal preparations to restore hormonal balance and in the use of phytotherapeutic agents.

The Borovaya uterus, which has an anti-inflammatory hormone-stabilizing effect, has proven itself well. Boron uterus well helps to fight fibroids and allows you to achieve tumor involution. Also Borovaya uterus shows high efficiency in the treatment of fibroids and fibromyomas.

Boron uterus blocks the production of prostaglandins - substances responsible for the development of the inflammatory process, helps to effectively eliminate infection in chronic endometritis, and also restores the balance between progesterone and tarragon.

Surgical treatment is used in cases where the tumor is large and interferes with the normal functioning of the body. Also, surgical intervention is resorted to in the development of complications associated with bleeding, the birth of a myoma node or tumor necrosis as a result of a violation of the trophism of the tumor leg.

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Although masses in the pelvis Increasingly discovered incidentally on CT or MRI for other indications, physical examination remains the most common method of early diagnosis. When making a diagnosis, the size, shape, boundaries, consistency and localization of the formation are taken into account.

benign tumors, usually smooth, cystic, mobile, unilateral, less than 8 cm in diameter (for comparison, the exact diameter of a tennis ball is 7 cm). Malignant neoplasms of a dense consistency, uneven, fixed, often with the formation of nodules in the recto-uterine cavity, accompanied by ascites. According to Koonings, the risk of malignancy in women with bilateral adnexal masses is 2.6 times higher than those with unilateral ones.

Before surgical intervention conduct a comprehensive examination. X-ray examination of the abdominal cavity allows you to evaluate the contour of the formation, the detection of teeth is a sign of benign teratoma. However, not all calcifications are teeth. For example, serous adenocarcinoma of the ovary may contain radiopaque psammoma bodies. With intravenous pyelography, the position and function of the kidneys are revealed, and it is also possible to estimate the size of the tumor by the nature of the displacement of the ureters and deformation of the boundaries of the bladder. This method is especially indicated for a planned surgical intervention to remove a retroperitoneal tumor.
Sometimes for an accurate assessment origin volumetric education, it is necessary to conduct transvaginal ultrasound, CT or MRI.

For ovarian cancer diagnosis (OC) there are specific methods, such as the determination of tumor markers. Some germ cell tumors synthesize CG, lactate dehydrogenase (LDH), or a-fetoprotein (AFP), but in most cases, the measurement of these markers at the initial stages of the development of ovarian neoplasms is not statistically significant. Although the growth of serous cystadenocarcinomas is accompanied by an increase in the level of CA-125, at stage I the result is positive in about 50% of cases.

Need to use more radiopaque studies of the gastrointestinal tract, especially if the origin of the volumetric formation from the organs of the digestive system is suspected. The diagnostic value of ultrasound is not as great as expected, with the exception of cases of determining uterine or ectopic pregnancy. With the help of ultrasound, it is possible to establish the interface between dense tissue and fluid, as well as to distinguish solid formations from cystic ones.

However, these data do not provide any information for the treatment of the patient, therefore, with palpable tumors, this method can be neglected. Sometimes ultrasound helps to confirm the suspicion of a tumor of the uterus in patients who are obese or refuse other methods of examination. Its routine use in all cases of tubo-ovarian formations is not justified. Differential diagnosis of uterine fibroids and ovarian tumors can be performed using laparoscopy.

It is shown in all cases when source of education is unclear, and further treatment (surgical or conservative) depends precisely on its origin. This is especially true for patients of reproductive age with small masses (< 7 см), когда возможна выжидательная тактика.

Irrigogram of a patient with a large mucinous cystadenoma of the right ovary, filling the pelvis and lower abdomen.

Decision on the need for surgery depends on the characteristics of the volumetric formation of the uterine appendages. Size more than 10 cm is an absolute indication for surgery. Ovarian cysts with a diameter of less than 5 cm in 95% of cases are non-tumor. In addition, functional cysts rarely exceed 7 cm in diameter and are usually unilateral and mobile.

As a rule, these female patients do not take oral contraceptives. It can be assumed that in the reproductive age, the volumetric formation of the appendages is most likely the result of functional or hyperplastic changes in the ovaries, and not a true tumor. The main difference between functional cysts and true tumors is the short duration of their existence.

According to clinical experience, lifetime of functional cysts ranges from several days to several weeks, and re-examination in the next phase of the menstrual cycle confirms this diagnosis. The appointment of oral contraceptives for the speedy involution of such cysts is based on the assumption that they depend on the secretion of gonadotropins. According to unconfirmed data, the inhibitory effect of contraceptive steroids on the release of gonadotropins reduces the period of existence of these formations, which makes it possible to quickly establish their functional, or non-tumor, nature.

If a functional cyst did not decrease in one menstrual cycle (4-6 weeks), surgical treatment is indicated. Spanos carefully examined 286 patients with adnexal cysts. They were prescribed combined oral contraceptives, re-examination was performed after 6 weeks. In 72% of cases, the formations disappeared during the observation period. Among 81 patients with persistent lesions, none had a functional cyst at the time of laparotomy. Five removed tumors turned out to be malignant, which emphasizes the groundlessness of the delay in surgical intervention in these patients.

Ultrasound cannot be called a universal diagnostic method, and, nevertheless, with the help of this examination alone, a gynecologist can make a diagnosis. Ultrasound can detect ovarian cysts, uterine fibroids, ectopic pregnancy, tumors, and other diseases. In this article, we will talk about how to decipher its results.

The gynecologist prescribes an ultrasound scan for the following symptoms:

irregular periods
Delay of menstruation
Pain in the lower abdomen
Uterine bleeding (long periods)
Infertility

If you suspect the following diseases:

Endometriosis of the uterus ()
and ovarian cyst torsion
Torsion of the ovary
Inflammation of the fallopian tubes ()
Inflammation of the endometrium (endometritis), etc.

How to prepare for an ultrasound?

Ask your gynecologist how the ultrasound will be performed. If the ultrasound is done through the abdomen, you will need to drink as much liquid as possible a few hours before the examination to fill your bladder.

If the ultrasound will be done through the vagina (transvaginal ultrasound), then it is not necessary to fill the bladder before the examination. A transvaginal ultrasound may cause some discomfort as the transducer will be inserted deep into the vagina. Ensure that the sonographer puts a sterile (new) condom on the transducer before the examination. This is a guarantee that no infection will be introduced during the study.

How to decipher the results of an ultrasound of the uterus?

After receiving the results of the ultrasound, you may be interested in what exactly the doctor wrote. We will learn what the main terms mean that sonographers write in their conclusions.

position of the uterus. The body of the uterus is in a certain position in the pelvis. Normally, the body of the uterus is tilted anteriorly, and the fold between the body of the uterus and the cervix forms an angle. In the conclusion of the ultrasound, this situation can be described in two Latin words: “ anteversio" and " anteflexio". This is the usual (normal) position of the uterus. If in the conclusion of the ultrasound it is written that the body of the uterus is in the position " retroversion», « retroflexio» this means that the uterus is tilted backwards and there is a posterior uterine fold. The backward bend of the uterus can indicate certain diseases, adhesions in the pelvis, and sometimes can cause infertility. There is a separate article on our website dedicated to this topic:
The size of the uterus. On ultrasound, 3 sizes of the uterus can be determined: transverse size, longitudinal size and anterior-posterior size. The longitudinal size (length of the uterus) is normally 45-50 mm (in women who have given birth up to 70 mm), the transverse size (width of the uterus) is 45-50 mm (in women who have given birth up to 60 mm), and the anterior-posterior size (thickness of the uterus) in the norm is 40-45 mm. Slight deviations in the size of the uterus are found in many women and do not indicate illness. However, too large size of the uterus can talk about uterine fibroids, adenomyosis, pregnancy.
M-echo. The thickness of the inner layer of the uterus (endometrium) is determined by ultrasound using M-echo. The thickness of the endometrium depends on the day of the menstrual cycle: the fewer days left until the next period, the thicker the endometrium. In the first half of the menstrual cycle, the M-echo ranges from 0.3 to 1.0 cm; in the second half of the cycle, the thickness of the endometrium continues to grow, reaching 1.8-2.1 cm a few days before the onset of menstruation. If you have already entered menopause (), then the thickness of the endometrium should not exceed 0.5 cm. If the thickness of the endometrium is too large, this may indicate endometrial hyperplasia. In this case, you need an additional examination in order to exclude.
The structure of the myometrium. The myometrium is the muscular, thickest layer of the uterus. Normally, its structure should be homogeneous. The heterogeneous structure of the myometrium may indicate adenomyosis. But do not be afraid ahead of time, as you will need an additional examination to clarify the diagnosis.

Uterine fibroids on ultrasound

Uterine fibroids are benign tumors that almost never develop into uterine cancer. With the help of ultrasound, the gynecologist determines the location of the fibroid and its size.

With fibroids, the size of the uterus is indicated in weeks of pregnancy. This does not mean that you are pregnant, but that the size of your uterus is the same as the size of the uterus at a certain stage of pregnancy.

The size of uterine fibroids can be different on different days of the menstrual cycle. So, in the second half of the cycle (especially shortly before menstruation), the fibroids increase slightly. Therefore, ultrasound with uterine fibroids is better to take place immediately after menstruation (on the 5-7th day of the menstrual cycle).

The location of uterine fibroids can be intramural (in the wall of the uterus), submucosal (under the inner lining of the uterus) and subserous (under the outer lining of the uterus).

Uterine endometriosis (adenomyosis) on ultrasound

Endometriosis of the uterus, or, is a disease in which the inner layer of the uterus (endometrium) begins to grow in the muscular layer of the uterus.

With adenomyosis, on an ultrasound of the uterus, the doctor finds that the myometrium (the muscular layer of the uterus) has heterogeneous structure with heterogeneous hypoechoic inclusions. In "translation into Russian" this means that in the muscular layer of the uterus there are sections of the endometrium, which has formed vesicles (or cysts) in the myometrium. Very often, with adenomyosis, the uterus is enlarged in size.

pregnancy on ultrasound

Ultrasound of the uterus during pregnancy is an extremely important diagnostic step. Here are just a few of the benefits of ultrasound during pregnancy:

Helps determine gestational age and fetal size
Helps to clarify the location of the fetus in the uterus
Helps identify
Helps to monitor the development of the fetus and identify any deviations in time
Helps determine the sex of the baby
Used during pregnancy
Used for holding

Ectopic pregnancy on ultrasound

If suspected, an ultrasound is performed through the vagina. Transvaginal ultrasound is more accurate, and allows you to detect ectopic pregnancy at an early stage, when complications have not yet developed. Ultrasound during an ectopic pregnancy helps determine the gestational age, the size of the fetus, and also clarify where it is located.

The main signs of an ectopic pregnancy on ultrasound are the presence of seals or heterogeneous structures in the fallopian tube. In the retrouterine space, the accumulation of fluid (blood) can be determined.

How to decipher the results of an ultrasound of the ovaries?

Ultrasound determines the size of the right and left ovaries, as well as the presence of follicles and cysts in the ovary. The normal size of the ovaries is on average 30x25x15 mm. A deviation of a few millimeters is not a sign of illness, since one or both ovaries may enlarge slightly during the menstrual cycle.

ovarian cyst on ultrasound

An ovarian cyst on ultrasound has the appearance of a rounded vesicle, the size of which can reach several centimeters. With the help of ultrasound, the doctor can not only determine the size of the ovarian cyst, but also suggest (follicular cyst, corpus luteum cyst, dermoid cyst, and so on).

Polycystic ovaries on ultrasound

When their size is much higher than the norm, which is noticeable during ultrasound. The volume of the ovary also increases: if the normal volume of the ovary does not exceed 7-8 cm3, then with polycystic ovaries it increases to 10-12 cm3 or more. Another sign of polycystic ovaries is a thickening of the ovarian capsule, as well as the presence of many follicles in the ovary (usually more than 12 follicles with a diameter of 2 to 9 mm).

Recently, ultrasound diagnostics has taken a leading position among diagnostic methods in gynecology. This is due to the availability, informativeness and safety of the method. However, it has a number of difficulties due to the variability of the ultrasound pattern depending on the day of the menstrual cycle, the number of previous pregnancies, and the duration of menopause.

In this regard, high professionalism and clinical thinking are required from the doctor conducting the study.

It should be understood that the sensitivity of the method is variable and depends on the diagnosed pathology. Even conducting a study on an expert-class apparatus does not guarantee an unequivocal diagnosis.

There are groups of pathological processes that have a similar ultrasound picture. Therefore, a qualitative examination should be comprehensive and include laboratory, instrumental research methods, as well as examination data and anamnesis.

The uterus is the largest organ of the female reproductive system, which is well differentiated by ultrasonography.

This allows diagnosing volumetric formations even of small sizes. Based on the visualized picture, all formations can be divided into three groups: hypoechoic, isoechogenic and hyperechoic.

Isoechoic formations have the same acoustic density as the surrounding tissue.

Hypoechoic formations have a lower acoustic density and appear darker on ultrasound examination against the background of the underlying tissue of the organ. Hyperechoic inclusions have a high acoustic density and are visualized as lighter against the background of uterine tissues.

To describe the focal pathology of the uterus, the terms of inclusion and formation are used. There is no fundamental difference in their use, and the use of both terms is legitimate and permissible in relation to any focal process.

Hyperechoic formations in the uterus have a different nature. The main reasons for their appearance are:

Intrauterine contraceptives. One of the most common types of contraception at present, although there are often complications of use (inflammatory processes, perforation of the walls of the uterus, violation). The ultrasound picture is different and depends on the type of intrauterine contraceptive. The most commonly used T-shaped. When properly placed, it appears as a linear hyperechoic structure during a longitudinal scan and as a rounded mass with smooth contours when the transducer is positioned transversely.

Intrauterine contraceptives, cysts - Uterus and adnexa - Ultrasound

With the correct location, the hyperechoic inclusion reaches the bottom of the uterine cavity and does not protrude beyond the internal os. When used as an intrauterine contraceptive, the Lipps loop, the ultrasound picture is characterized in transverse scanning by the detection of an entire hyperechoic line and individual inclusions of increased echogenicity in longitudinal. When the uterus is perforated with an intrauterine contraceptive, a hyperechoic inclusion is determined, partially located in the thickness of the myometrium. Most often this occurs in the fundus of the uterus.

Chronic endometritis. This process is due to endometrial hyperplasia and can occur in any age group. The ultrasound picture of hyperplasia is variable, more often it looks like hyperechoic inclusions of small size (2-7 mm) with clear contours, irregular shape, expansion of the uterine cavity is possible. In women of reproductive age, thickening of the endometrium and hyperechoic inclusions persist in all phases of the menstrual cycle.

endometrial polyps. In most cases, they have an isoechogenic structure, however, if there are a large number of fibrin filaments in the structure of the polyp, this leads to an increase in the echogenicity of the formation. Fibrous polyps have a similar ultrasound picture with endometritis. Distinctive features are the presence of clear, even contours, a round shape during transverse scanning. There is a violation of the closure of the mucous sheets, its contours become wavy, intermittent. With color, the vascular pedicle of the polyp is revealed, which consists of newly formed vessels that feed the formation.

In reproductive age, the study is optimally carried out in the proliferative phase of the menstrual cycle.

Air bubbles. These formations in the lumen of the uterus may appear as a result of curettage of the uterus, as well as with a long course of chronic endometritis. Ultrasound visualizes a hyperechoic formation with clear contours, often multiple and small in size. Sometimes there is an acoustic effect of the "comet tail", which is visualized as many echogenic bands behind the formation.
Remains. The echographic picture is variable and depends on the one in which the abortion occurred. If chorion tissues remain, then the ultrasound picture is characterized by a heterogeneous structure and increased echogenicity. If abortion occurs at a later date, then fragments of bone structures are visualized as hyperechoic formations with clear contours and an acoustic shadow.
Hematometer. Blood clots in the lumen of the uterus may remain after surgery or delivery. The study visualizes an enlarged uterus with hyperechoic heterogeneous inclusions without signs of blood flow using Doppler. With ultrasound, they have a similar picture with the remnants of the chorion. When conducting differential diagnosis, dynamic observation is of great importance. Over time, blood clots undergo destructive changes and are displaced in relation to the walls of the uterus. The components of the chorion practically do not change their structure and location over time.
Perforation of the uterus and uterovesical fistula. The visualized picture is characterized by the detection of a 4-6 mm thick band of increased echogenicity passing through the tissues of the uterus. It is characterized by the presence of its communication with the uterine cavity. The acoustic shadow is not detected in this case. With a long course, endometritis may occur with a corresponding ultrasound picture.
Inflammation of postoperative sutures. The inflammatory process is manifested by an increase in the thickness of infiltration in the area of postoperative sutures on the uterus. Also, due to the deposition of fibrin threads, a plaque of increased echogenicity appears, more often of a linear nature.

More rare causes of foci of increased echogenicity, which are often not taken into account, are submucosal myomatous node and lipoma.

They have a hypoechoic structure, however, submucosal nodes are prone to degenerative processes and the formation of calcified areas. It is these areas that look like inclusions of increased echogenicity against the general background of a hypoechoic or isoechoic node.

myomatous focus of altered and uneven echogenicity

Lipoma is a benign tumor of adipose tissue cells. It is considered extremely rare, partly due to the onset at an older age (after 50-60 years) and the asymptomatic course of the disease. The ultrasound picture is characterized by the presence of a mass with clear contours, increased echogenicity and the absence of blood flow in color Doppler mapping.

hyperechoic focus - lipoma from adipose uterine tissue

When hyperechoic formations are found in the uterus, it is not always possible to unambiguously make a diagnosis based on the ultrasound picture. If there is any doubt about the nature of this formation, a full examination is necessary. Important in the differential diagnosis are:

Anamnesis data (previously performed operations for the diagnosis of hematomas and inflammation of postoperative sutures, the use of intrauterine contraceptives in their diagnosis and diagnosis of complications, termination of pregnancy to identify remnants of the chorion and fragments of the skeleton).

Clinical data and complaints of the patient (pain syndrome, menstrual irregularities with endometritis, polyps and remnants of the fetal egg).
Diagnostic laparoscopy (with suspicion of uterine perforation and presence of uterovesical fistula).
Hysteroscopy (in the presence of polyps and myomatous nodes).
Magnetic resonance imaging with the difficulties of differential diagnosis and the impossibility of making a diagnosis based on the studies already conducted.

When diagnosing, it is necessary to take into account the day of the menstrual cycle when diagnosing, with a dubious ultrasound picture, it is necessary to repeat the study in another phase of the cycle, which will allow more accurate interpretation of the data obtained. Ultrasound diagnosis of the pelvic organs, and in particular the uterus, requires high professionalism and experience from the doctor conducting the study.