title: Echogenic foci mimicking adenomyosis presumably due to air intravasation into the myometrium during sonohysterography.
abstract: OBJECTIVE
  To report the radiological findings of a pseudolesion in the myometrium mimicking adenomyosis presumably due to air intravasation during sonohysterography (SHG).
  
  
  METHODS
  We searched magnetic resonance imaging (MRI) and transvaginal ultrasound (TVUS) examination results before and after SHGs, in which echogenic foci were found suggesting adenomyosis in the myometrium, and found 7 female cases. MRI and TVUS findings were compared to the SHG findings to assess the persistence of echogenic foci seen with SHG and other imaging modalities, and to exclude the possibility of pseudolesions secondary to saline-air intravasation into the myometrium during SHG.
  
  
  RESULTS
  Ages of the 7 patients ranged from 27 to 60 years; 2 of them were postmenopausal. SHG examinations showed solitary or multiple echogenic foci measuring 4-15 mm, with acoustic shadowing, which were adjacent to the endometrium and consistent with adenomyosis. Only 1 of the patients underwent both MRI and TVUS, 2 of them had TVUS after SHG, and 1 had TVUS before SHG; the 3 remaining patients had TVUS as a baseline examination prior to SHG. None of these TVUS or MRI examinations confirmed the echogenic foci found with SHG.
  
  
  CONCLUSIONS
  In order to differentiate echogenic myometrial pseudolesions from true adenomyosis lesions, a detailed preliminary TVUS is essential before any SHG procedure. If such lesions are encountered despite meticulous care to avoid the inadvertent introduction of air into the endometrial cavity, TVUS findings should be reviewed and a pelvic MRI is recommended in cases with heterogeneous myometrium.
authors.affiliation: Department of Radiology, Gülhane Military Medical Academy, Ankara, Turkey. drfors@yahoo.com
authors.forename: Fatih
authors.initials: F
authors.lastname: Ors
authors.forename: Anna S
authors.initials: AS
authors.lastname: Lev-Toaff
authors.forename: Diane
authors.initials: D
authors.lastname: Bergin
mesh_terms: D000328:Adult; D004618:Embolism, Air / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D004715:Endometriosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000009:adverse effects*; D008499:Medical Records; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D014463:Ultrasonography