Differential Diagnosis
- Single most likely diagnosis
- Adenomyosis: The heterogeneity of the myometrium is a strong indicator of adenomyosis, which is a condition where endometrial tissue grows into the uterine wall. The presence of a 13 mm endometrium, which is considered within the normal range, and subcentimeter uterine fibroids also supports this diagnosis.
- Other Likely diagnoses
- Uterine fibroids: Although the fibroids are subcentimeter, they could still be contributing to the patient's symptoms, especially if they are numerous or located in a specific area of the uterus.
- Ovarian follicular cyst: The 2.5 cm left ovarian follicular cyst could be a simple cyst or a corpus luteum cyst, which are common and usually benign.
- Endometriosis: Although not directly mentioned, the presence of adenomyosis and a thick endometrium could suggest endometriosis, especially if the patient has symptoms such as pelvic pain or heavy bleeding.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ovarian torsion: Although the ovarian cyst is only 2.5 cm, there is still a risk of ovarian torsion, which is a medical emergency that requires prompt attention.
- Uterine sarcoma: Although rare, uterine sarcomas can present with similar symptoms and imaging findings as adenomyosis or fibroids, and would require prompt diagnosis and treatment.
- Endometrial cancer: A thick endometrium, even if considered functional, could be a sign of endometrial cancer, especially in postmenopausal women or those with risk factors.
- Rare diagnoses
- Uterine arteriovenous malformation (AVM): A rare condition that could cause heterogeneity of the myometrium and other symptoms.
- Ovarian cancer: Although the ovarian cyst is likely benign, there is still a small chance that it could be a malignant tumor, especially if the patient has risk factors or symptoms such as pelvic pain or bloating.