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Ultrasonographic appearances of uterine pathology. Nulliparous uterus measures 7 x 5 x 3 cm.

Endometrial Stripe (ES) thickness

Striated appearance of ES (triple layer) at mid cycle around ovulation ⇒ endometrium particularly receptive to implantation.

Tamoxifen (breast ca th.) has estrogenic effect causing endometrial hyperplasia with cysts and increased risk for endometrial carcinoma

Junctional zone

Hypoechoic layer surrounding endometrium (better seen on MRI)

Distorted by:


Uterine endometriosis - extension of endometrium into the myometrium causing distortion of the junctional zone (multiple small hypoechoic lesions: moth-eaten appearance), small subcentimeter cysts in myometrium, enlarged uterus; MRI best for diagnosis


most commonly hypoechoic solid mass, however it can be heterogeneous to hyperechoic, show posterior acoustic shadowing, may calcify and necrose (hypoechoic areas within an solid mass)

Uterine Versions

Postpartum Endometritis and RPOC

RPOC: Retained Products Of Conception

ES > 15 mm, fluid collection and gas (bright reflectors)

DDx: Ovarian vein thrombosis almost always occur on the right side and cause pain and fever


Premenstrual vaginal fluid collection from vaginal atresia, vaginal septum or imperforate hymen

Hematometros and Pyometros

Fertile age fluid collection in the uterus: blood or pus

Postmenopausal fluid collection in the uterus is never a normal finding → cervical stenosis or obstructing endometrial or cervical carcinoma, may become infected → Pyometros and septic

Postmenopausal ES > 5mm

Usually present with vaginal bleeding → Endometrial bx or Sonohysterogram → Hysterectomy

Endometrial Atrophy

Postmenopausal vaginal bleeding with normal ES < 5mm