Mt. Baldwin et al., Focal intracavitary masses recognized with the hyperechoic line sign at endovaginal US and characterized with hysterosonography, RADIOGRAPHI, 19(4), 1999, pp. 927-935
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.