Thursday, November 22, 2012

Sonography in the case of pedunculated polyp

This young woman is 25 years age and is a lactating mother. Her child is nine months age. At present she complains of profuse bleeding per vagina, since the past one week. She also has mild discomfort in the pelvis. Her mother was no significant tenderness of pain in the pelvic region. Ultrasound images both transabdominal and transvaginalshow a large polypoid mass of 1.2 to 1.5 cm protruding from the lower segment of the uterus to the cervix, or to be more precise into the endocervical canal.
In addition there is a cystic fluid collection in the endocervical canal which may be due to obstruction to the outflow from the cervix. Since the patient had regular menses, prior to the scan, the possibility of this cystic lesion in the cervix being a cervical pregnancy or an abortion in progress is not likely.
shown below are transabdominal ultrasound images of the uterus showing the large polyp protruding into the endocervical canal from the lower part of the body of the uterus or to be more precise from the endometrium of the body of the uterus. There is also a colour Doppler image showing limited vascularity in this region. The polyp itself does not show significant vascularity.

And below are shown some excellent transvaginal ultrasound images of the same case showing the polyp clearly bulging into the fluid filled endocervical canal. what appears unusual is the limited or rather poor vascularity in that large pedunculated cervical polyp.

In the last ultrasound image at the bottom, observe how the polyp is literally surrounded by fluid in the endocervical canal.
looking to the large size of the polyp and also the lack of vascularity in these ultrasound and colour Doppler images the possibility of this lesion being a pedunculated fibroid is also a likelihood. 

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