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Polypoid endometrium on three‐dimensional saline contrast sonohysterography

Endometrial abnormalities are often diagnosed in women with a history of abnormal uterine bleeding. The differential diagnosis between focal and global endometrial lesions has been facilitated by the use of saline contrast sonohysterography, which has proved to be more effective than has non-enhanced B-mode transvaginal ultrasound1. The most common focal endometrial lesions are benign endometrial polyps. However, endometrial carcinoma may also present as a focal polypoid lesion within the uterine cavity. In premenopausal women, the differential diagnosis also includes submucous fibroids, which sometimes protrude into the uterine cavity, forming polyp-like lesions. Multiple endometrial polyps are found in approximately 20% of cases2. It is unusual, however, to find more than two to three polyps in individual cases. A large number of concomitant polyps, which is sometimes referred to as ‘endometrial polyposis’, are a rarity. Here, we present a case of polypoid endometrium, which resembled endometrial polyposis on transvaginal ultrasound examination. A 39-year-old woman attended for an ultrasound scan with a history of intermenstrual bleeding and primary infertility. Twelve years previously she had undergone a colposcopy and cervical biopsy, but her smear tests were normal following this. In 2001 she underwent a hysteroscopy and polypectomy. She continued to experience intermenstrual bleeding, but another hysteroscopy in 2003 revealed no endometrial abnormalities. She was in good general health and she was not on any regular medication. Her baseline hormone profile was normal. On ultrasound examination, a small subserous fibroid was noted, which was not affecting the uterine cavity. On B-mode examination, the endometrium appeared irregular and the midline echo was disrupted. On Doppler examination, the endometrium appeared poorly vascularized. The ovaries were normal. Three-dimensional saline contrast sonohysterography was performed, revealing more than 20 polypoid lesions arising from the endometrium (Figure 1). A Figure 1 Coronal section of the uterus obtained on three-dimensional saline contrast sonohysterography showing multiple polyp-like lesions within the endometrial cavity.