Author: Jaskirat Virk
Ultrasound Hysterosalpingogram CT MRI - T1 MRI - T1 MRI - Post-contrast T1 Gross Pathology Histology Additional comments
Endometrial Hyperplasia Thickened endometrium (calipers) with cystic areas. Endometrial thickening (black arrow) is seen, representing endometrial hyperplasia. A large, predominantly cystic mass with several small solid components in the left adnexa (white arrow) was found to be a granulosa cell tumor of the left ovary. A hypoattenuating intrauterine mass (arrowhead) was found to be endometrial carcinoma. Thickened endometrium (arrowheads) and myometrium. The endometrium is thickened in a heterogeneous manner, a finding consistent with endometrial hyperplasia. The thickened junctional zone in the posterior uterine wall (☆) is indicative of adenomyosis. A leiomyoma (arrows) is present in the anterior uterine wall.
Endometrial polyp Well-marginated, polypoid mass projecting into the endometrial cavity (white arrow). Pedunculated filling defect within the uterine cavity (arrows). Low-signal-intensity lesion within the endometrial canal (arrow). Intratumoral cysts (C) and the fibrous core (F) in the polyp adjacent to the myometrium (M).
Endometrial adenocarcinoma Heterogeneous endometrial mass (arrows) that is difficult to distinguish from the myometrium. Cursors indicate the entire transverse width of the uterus. Large irregular filling defects are seen. Dilated endometrial canal (*) and multiple low-attenuation areas (arrows) in the deep myometrium, cervix, and upper vaginal canal.

Image 2
A mass (M) in the submucosal area of the posterior region. The mass is hyperintense relative to the myometrium. Heterogeneously enhancing masslike lesion. (arrowheads).
Fibroid Are all hypoechoic, broad based, and well circumscribed, and they displace the endometrium to varying degrees. Smooth filling defects distorting the uterine cavity. Mass (arrows) anterior to the fundus of the uterus (u) with coarse mass-type calcifications and peripheral rim calcification. Although uncommon, these mass-type calcifications in a possible uterine mass should suggest the diagnosis of a leiomyoma. Typically have a uniformly solid consistency, with attenuation values similar to those of the uninvolved uterus. Intramural masses (straight arrows), which have lower signal intensity than the myometrium on the T2-weighted image and higher signal intensity on the T1-weighted image Diffusely enlarged uterus with multiple leiomyomas. Each leiomyoma has clear margins and distinct low signal intensity. Uniform cellular neoplasm composed of whorls of smooth muscle cells with little intervening collagen
Leiomyosarcoma Impossible to distinguish from a fibroid. Typically have a uniformly solid consistency, with attenuation values similar to those of the uninvolved uterus. Sudden accelerated growth of a previously static tumor or postmenopausal enlargement of a uterine mass should suggest this diagnosis (M). Heterogeneous mass with evidence of degeneration. Tumor (M) with slightly high signal intensity and irregular margins. The tumor protrudes from the posterior myometrium into the endometrial cavity (arrows). Small leiomyomas (m) with clear margins are present in the anterior wall. An infiltrating sarcoma (arrows) is seen. * = draining vein.
Asherman's syndrome Multiple uterine synechiae (arrows) can be seen. Several linear intrauterine filling defects (arrowheads). Uterine synechiae at virtual hysterosalpingography. Volume-rendered image shows a linear defect (arrow) that extends from the uterine fundus to the body, a finding suggestive of a synechia. Image obtained near the fundus shows the most superior synechiae crossing the endometrial cavity (arrow). Hysteroscopic view of synechiae.
Adenomyosis Enlarged, globular uterus with diffusely heterogeneous echotexture of the myometrium and small myometrial cysts. Characteristic saccular contrast material collections (arrowheads) protruding beyond the normal contour of the endometrial cavity. Enlarged uterus with posterior thickening of the myometrium and multiple small cystic areas (arrows). Several foci of increased signal intensity (arrowheads), which correspond to areas of hemorrhage within the adenomyotic tissue Indistinct zonal anatomy. Widening of the junctional zone is clearly seen in the region around the distorted endometrium (arrowheads). The myometrium has decreased signal intensity with tiny spots of high signal intensity (arrows). Multiple hemorrhagic cysts within a thickened myometrium. Several islands of ectopic endometrial glands (*) surrounded by whorled hypertrophic smooth muscle.
Endometritis Multiple echogenic foci within the endometrium (arrow) representing gas. Enlarged postpartum uterus with an endometrial cavity expanded by fluid, debris, and a moderate amount of air. A small amount of associated ascites is also seen. Intense enhancement of the uterus with particularly prominent cervical enhancement (arrowheads). The cervix does not usually enhance so intensely unless it is significantly inflamed. The fluid seen in the endometrial cavity was found to be pus. The incision site for cesarean section in the anterior uterine wall (arrow). The uterus is enlarged with overall high signal intensity. The air (arrowhead) resulted from sanitization of the endometrial cavity.
Hydrosalpinx Tubular-shaped cystic mass. The finding of indentations (arrows) on opposite sides of the tubular mass, termed the waist sign, is a good indicator of a hydrosalpinx. Dilatation of the left fallopian tube (arrow) with an absence of contrast material outflow, findings indicative of tubal occlusion, and a patent normal right tube (arrowhead) with outflow of contrast material. Simple folded fluid-attenuation tubular structures in the bilateral adnexa with no adjacent inflammatory stranding or free fluid. Tortuous tubular structure with hyperintense signal (arrow) in the left adnexa. Sausage-shaped, dilated right fallopian tube (arrows).
Salpingitis isthmica nodosa (SIN) Tubal irregularity due to salpingitis isthmica nodosa. Multiple contrast material–filled luminal pouches (arrowheads) projecting 2–3 mm outward from the isthmic portion of both fallopian tubes.
Pyosalpinx Hypoechoic tubular structure (arrow) containing echogenic debris. There is no internal blood flow; however, there is increased surrounding vascularity. Enhancing, dilated fallopian tubes filled with complex fluid (arrows) and a 7 × 8-cm cul-de-sac abscess, findings that are consistent with pyosalpinx and tubo-ovarian abscess. Thickened enhancing wall of the dilated fallopian tube (solid arrows) and ovary (open arrow), findings suggestive of pyosalpinx and tubo-ovarian abscess. Adherence of the dilated right fallopian tube (solid white arrows) to the right ovary (open arrow). There is a fluid-fluid level (black arrow) and incompletely effaced plicae (arrowheads). Pus-filled, dilated fallopian tubes (arrows).
Septate Uterus Solid mass (arrow) between two endometrial canals. The echotexture of the mass is compatible with that of myometrium. Depression of the uterine fundus, a finding that may represent a short septum or an arcuate deformity. Acute angle of divergence between uterine horns is most suggestive of a septate uterus. Virtual hysterosalpingography depicts a septate uterus. Low-signal-intensity fibrous septum (arrowhead) that extends to the external cervical os (arrow). Hysteroscopic image shows intervening septum (arrow).
Bicornuate uterus Two cervixes (curved arrows) and a septum that extends to the internal os (straight arrow). Two markedly splayed uterine horns. Features of a bicornuate uterus are separate uterine horns, the deep fundal cleft, and the contiguity of each uterine horn with the cervix and vagina. Two symmetric uterine horns (arrowheads) with a deep fundal cleft (arrow). Hysteroscopic view shows two diverging uterine horns.
Uterine didelphys Two divergent uterine horns (arrows) Two HSG images show catheterization of two separate cervices with opacification of two widely divergent noncommunicating endometrial cavities (arrow).

Image 2
High-signal-intensity material distending the right endometrial cavity and cervix (arrowheads), a finding indicative of right hematometrocolpos. An obstructive horizontal right vaginal septum was subsequently resected. Two divergent uterine horns (arrows) with distention of the right endometrial cavity (arrowheads).