Case history
Case history #1
A 45-year-old woman presents with chronic pelvic pain and menorrhagia. She reports having her first period at age 11 years, and has a history of subfertility but went on to conceive two children without the aid of assisted reproductive techniques. On examination, she has a body mass index (BMI) of 38; general examination is otherwise normal. Bimanual examination finds a diffusely enlarged uterus. A routine complete blood count reveals a hemoglobin level of 12 g/dL. She has no desire for future pregnancy. A transvaginal ultrasound (TVUS) shows an enlarged, asymmetric uterus measuring 12 × 7 × 5 cm with scattered hypoechoic myometrial cysts.
Case history #2
A 21-year-old nulliparous patient presents with dysmenorrhea, menorrhagia, and dyspareunia. She has expressed a desire for future conception. She has no significant medical or surgical history, smokes five cigarettes per day, and has a BMI of 24. The patient has previously tried nonsteroidal anti-inflammatory drugs (NSAIDs) to manage her symptoms, but without success. On pelvic examination, the patient is found to have a tender, globular uterus. TVUS reveals an enlarged, globular uterus measuring 12 × 6 × 6 cm, featuring hypoechoic myometrial cysts confined to the posterior uterine wall and echogenic subendometrial buds with disruption of the junctional zone.
Use of this content is subject to our disclaimer