Differential Diagnosis for Bulky Uterus with Thickened Endometrium and Fluid in Endometrium on USG

• Single Most Likely Diagnosis
  • Endometrial Hyperplasia: This condition is characterized by the thickening of the endometrium, which can be due to hormonal imbalance, leading to excessive estrogen exposure without sufficient progesterone. The presence of fluid within the endometrium could be indicative of secretory changes or early signs of malignancy, but in the context of a bulky uterus and thickened endometrium, hyperplasia is a strong consideration.
• Other Likely Diagnoses
  • Endometrial Polyps: These are growths in the endometrium that can cause thickening and irregularities, potentially leading to a bulky appearance on ultrasound. They can also cause irregular menstrual bleeding.
  • Submucosal Fibroids: Uterine fibroids that grow into the uterine cavity can cause the endometrium to appear thickened and can lead to a bulky uterus. They can also cause irregular bleeding and are a common finding in women of reproductive age.
  • Endometrial Cancer: Although less common than benign conditions, endometrial cancer must be considered, especially in postmenopausal women or those with risk factors such as obesity, diabetes, or a family history of cancer. The presence of fluid and thickening could be indicative of a tumor.
• Do Not Miss Diagnoses
  • Pyometra: This is an accumulation of pus in the uterine cavity, often seen in postmenopausal women, which can mimic the appearance of fluid in the endometrium on ultrasound. It's a serious condition that requires prompt treatment to prevent complications.
  • Invasive Mole or Choriocarcinoma: Although rare, these gestational trophoblastic diseases can cause uterine enlargement and irregularities, including fluid accumulation within the uterus. They are critical to diagnose early due to their potential for malignancy and metastasis.
• Rare Diagnoses
  • Adenomyosis: A condition where endometrial tissue grows into the uterine wall, leading to a bulky uterus. While it can cause thickening of the endometrium, it's more commonly associated with a diffusely enlarged uterus rather than focal thickening.
  • Uterine Sarcomas: These are rare malignant tumors of the uterus that can cause rapid uterine enlargement and irregularities, including fluid accumulation. They are much less common than other uterine pathologies but are important to consider due to their aggressive nature.