Expulsion of an adenomyotic lesion into the uterine cavity after ablation by high-intensity focused ultrasound

A 46-year-old woman, gravida 5 para 0, with a 10-year history of dysmenorrhea, was admitted to our hospital. Her symptoms worsened about 6 months before her admission, affecting her sleep. Magnetic resonance imaging (MRI) showed that the uterine wall was asymmetrically thickened, with evident thickening and abnormal signal at the junctional zone (JZ), particularly the posterior wall and fundus (Figure 1A). A diagnosis of adenomyosis was made. As the patient had not yet given birth and wished to preserve her uterus, she chose HIFU ablation. The intense ultrasound waves generated by the HIFU system penetrated the abdominal wall and focused on the lesion of the posterior wall. Clotting necrosis has occurred in the targeted area with increasing temperature [1-2]. The patient did not experience any obvious discomfort during and after the HIFU ablation. MRI on the second day after HIFU ablation showed obvious unimproved mass areas in the lesion (Figure 1B).

Figure 1Magnetic resonance imaging (MRI) showing internal adenomyosis lesion before and after high intensity focused ultrasound (HIFU) ablation. A. Before HIFU ablation. Asymmetrical widening of the myometrial wall and irregular thickening of the junctional zone. No intrauterine mass; B. The second day after HIFU ablation. No perfusion area of ​​about 4 cm after HIFU treatment; C. Three months after HIFU ablation. A 3.9 × 3.2 cm hypoechoic mass in the uterine cavity with a clear boundary and no blood flow signal.

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