ULTRASOUND-GUIDED HYSTEROSCOPIC MANAGEMENT OF ENDOMETRIAL OSSEOUS METAPLASIA

In the past, most cases of osseous metaplasia of the endometrium were diagnosed following removal of bone from the endometrium by dilatation and curettage and frequently subsequently treated by hysterectomy. No wadays, management involves a suggested diagnosis by transvaginal ultr asound examination, confirmation by hysteroscopy and hysteroscopic rem oval of ectopic intrauterine bone. This is usually carried out under l aparoscopic guidance. However, the degree of visual control provided b y combined transabdominal and transrectal ultrasonography may prove su fficiently accurate for hysteroscopic guidance. In this report we desc ribe a case of endometrial osseous metaplasia successfully managed by ultrasound-guided hysteroscopy. The advantages of our approach include reduced invasiveness, reduced costs and simultaneous visualization of the abdominal and intrauterine cavities. One limitation, however, is represented by the greater operator dependence of ultrasound guidance as compared to laparoscopy, the former requiring extensive training an d state-of-the-art equipment. We suggest that ultrasound guidance for hysteroscopic removal of extensive osseous metaplasia may represent a potentially safer and more effective alternative to laparoscopy and wo uld therefore encourage further clinical evaluation of this technique.