title: False-normal appearance of the endometrium on conventional transvaginal sonography: comparison with saline hysterosonography.
abstract: OBJECTIVE
  The objective of this article is to assess the utility of transvaginal saline hysterosonography in patients presenting with a normal-appearing endometrium on conventional transvaginal pelvic sonography.
  
  
  METHODS
  Between August 1997 and October 1999, 180 patients underwent saline hysterosonography for abnormal vaginal bleeding. All patients had conventional transvaginal pelvic sonography before saline hysterosonography. On conventional transvaginal sonography, the sonographic appearance of the endometrium was classified according to the following parameters: normal or abnormal thickness, homogeneous or heterogeneous echogenicity, bulbous contour, discontinuous, or obscured. A comparison was performed between the endometrial appearance on conventional transvaginal sonography with that of the uterine cavity on saline hysterosonography.
  
  
  RESULTS
  Saline hysterosonography showed abnormalities in 114 patients. Polyps were identified in 53 patients, submucosal leiomyomas in 37 patients, uterine anomalies in two patients, a uterine anomaly and a submucosal leiomyoma in one patient, uterine synechiae in three patients, a synechia and a polyp in one patient, thick endometrial walls in six patients, nondistensible cavities in two patients, and polyps and submucosal leiomyomas in nine patients. Sixteen (14%) of 114 patients showed abnormalities (polyps and submucosal leiomyomas) on saline hysterosonography despite normal-appearing endometria on conventional transvaginal sonography.
  
  
  CONCLUSIONS
  Conventional transvaginal pelvic sonography does not appear to be a screening procedure of sufficient diagnostic value in the symptomatic patient with abnormal vaginal bleeding. In patients presenting with the chief complaint of abnormal vaginal bleeding, diagnostic evaluation with a saline hysterosonogram may be warranted despite normal findings on a transvaginal pelvic sonogram.
authors.affiliation: Department of Radiological Health Sciences, UCLA School of Medicine, 10833 LeConte Ave., Los Angeles, CA 90095, USA.
authors.forename: Sherelle
authors.initials: S
authors.lastname: Laifer-Narin
authors.forename: Nagesh
authors.initials: N
authors.lastname: Ragavendra
authors.forename: Evelyn K
authors.initials: EK
authors.lastname: Parmenter
authors.forename: Edward G
authors.initials: EG
authors.lastname: Grant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging*; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D004717:Endometrium / Q000000981:diagnostic imaging; D019160:Endosonography; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*; D014599:Uterus / Q000002:abnormalities / Q000000981:diagnostic imaging