Focal intracavitary masses recognized with the hyperechoic line sign at endovaginal US and characterized with hysterosonography

In 42 women, endovaginal ultrasonography (US) was performed because of an a bnormal central endometrial complex. Retrospective review of the endovagina l US scans and subsequently obtained hysterosonograms with histopathologic correlation showed a hyperechoic line surrounding the central endometrial c omplex in 25 patients, all of whom had focal intracavitary processes. Cysti c spaces within the central endometrial complex in 17 of these patients ref lected polyps; this finding was associated with a hyperechoic line in 15, A t hysterosonography, all polyps (n = 29) had a narrow attachment to the end ometrium. All five fibroids were broadly attached and had a rim of overlyin g endometrium, These focal abnormalities were easily distinguished from glo bal endometrial processes amenable to a blind biopsy procedure. This initia l experience showed that a hyperechoic line circumscribing the central endo metrial complex at endovaginal US allows prediction of focal intracavitary disease, particularly when the line is associated with cystic spaces within the central endometrial complex. The presence of a hyperechoic line can be used to direct the patient to a visually guided hysteroscopic procedure ra ther than a potentially unsuccessful blind biopsy procedure. Alternatively, absence of a hyperechoic line can prompt management appropriately directed by hysterosonographic characterization of the uterine contents as focal or diffuse.