Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease

study objective: to evaluate the ultrasound features, types, and degrees of adenomyosis among adolescents and to correlate these findings with clinical symptomsdesign: a retrospective observational study.setting: gynecological ultrasound units from January 2014 to June 2020.patients: a total of 43 adolescents (aged 12-20 years) who were diagnosed as having adenomyosis at a pelvic ultrasound examination. interventions: ultrasound features and location and type of adenomyosis within the uterus were evaluated on stored 2dimensional images and videos and 3-dimensional volumes. adenomyosis was classified as mild, moderate, and severe according to the extension of the disease in the uterus as described in our previous published classification.measurements and ain results: adenomyotic features recorded among our population were myometrial hyperechoic areas, uterine wall asymmetry, intramyometrial cystic areas, and some types of junctional zone alterations. the posterior uterine wall (58%) and the outer myometrial layer (93%) were mostly affected. In 44% of adolescents (19/43) with adenomyosis, at least 1 location of pelvic endometriosis was documented. dysmenorrhea was the most commonly reported symptoms (88%), and it was associated with adenomyosis of the outer myometrium, myometrial hyperechoic areas, uterine wall asymmetry, and intramyometrial cystic areas. adolescents with dyspareunia showed diffuse adenomyosis (9/9 patients) including both the inner and outer myometrium (7/9 patients) and in the posterior wall (7/9 patients). heavy menstrual bleeding was associated with diffuse adenomyosis (18/23 patients) mostly of the outer myometrium (22/23 patients). Scoring system showed predominantly mild disease and no severe adenomyosis was found. adolescents with diffuse adenomyosis were significantly older and showed a high percentage of heavy menstrual bleeding compared with those with the focal disease of the inner myometrium . conclusion: this study shows that adenomyosis is not only a pathology of adult life, but it involves young patients mostly in a mild-to-moderate form and is associated with typical painful symptoms. In adolescents, the diagnosis of adenomyosis is feasible through a noninvasive way with ultrasound and a proper management can be set. (C) 2021 AAGL. All rights reserved.