·         Decidual reaction- Decidual reaction secondary to hormonal stimulation of the endometriUm is normally present in intrauterine pregnancy. Decidual reaction is represented sonograph ically by echogenic, thickened endometrium. Decidual reaction may occur in 20—50% of ectopic pregnancies.

 

·         Secretory phase of menstrual cycle- Sonography demonstrates cyclical changes in the normal endometrium. The endometrium becomes thickened and echogenic in the secretory phase.

 

·         Stimulated endometrium - The endometrium in postmeno pausal women is usually thin, no more than 4 mm. Hormonal stimulation by medications such as estrogens for osteoporosis may alter the thickness and echogenic ity of the endometrium.

 

·         Endometrial carcinoma

 

·         Endometrial hyperplasia- This is related to proliferation of glands and stroma caused by prolonged and persistent estrogestimulation, and is the most common cause of uterine bleeding. It can occur during menstrual years as well as in the postmenopau years. Classified pathologica into simple, complex and atypical

hyperplasia, the incidence of subsequent malignancy is as high 25—50% in the atypical variety.

 

·         Endometritis- Bacterial infection of the endometrium may occur Postpartum, following abortion or due to the presence of an IUCD. The uterus may appear normal or may be enlarged, with a wide echogen - cavity which may contain air or fluid.

 

·         Endometrial poly-

 

·         Penuculated endometrial loiomyomas-

 

·         Retained products of conception- The appearances of the ‘endomer rial complex’ depend upon the stage of the pregnancy at which abortion occurred and the tissue type of the retained product, e.g osseus.

 

·         Persistenet corpus luteum cysts- These cysts elaborate progesterone, which is likely to sustain secretory endometrium.

 

·         IUCD with progesterone- The combination gives rise to an echogenic and thickened endometrium.

 

·         Hematometra- This has several causes . The presence of blood within the endometrial cavity alters its echogenicity, depending on the stage of resolution of the blood/clot.

 

·         Malignant mixed Mullerian tumor- In common with other uterine tumors, particularly those involving the endometrium, malignant mixed Mullerian tumors may enhance the endometrial echoes.

 

·         Cervical pregnancy- The sonographic criteria for cervical pregnancy are: uterine enlargement, diffuse echogenic intrauterine echoes, enlarged cervix and absent intrauterine pregnancy.

 

·         Gestational trophoblastic disease

 

·         Adenomyosis- Characteristically cause uterine enlargement and contour anomaly with a normal central ech although on rare occasions this endometrial echo, complex may be prominent.

 

·         Tamoxifen therapy- Tamoxifen is widely used in the treatment of carcinoma of the breast. Several US abnormalitie of the uterine endometrium have been observed in these patients

(1) endometrial thickness >4 mm:

(2) endometrium may be hypoechoic, homogeneous or hyperechoic with multiple small cystic spaces;

(3) endometrial polyps with cyst within them;

(4) endometrial carcinoma.

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