USG IMAGING

CERVICAL AND ENDOMETRIAL POLYPS

 CERVICAL POLYP
• Cervical polyps are polypoid growths
projecting into the cervical canal. They can be
one of the most common causes of
intermenstrual vaginal bleeding.
• Most patients are perimenopausal at the time
of presentation, especially in the 5th decade of
life. They are the most common mass lesion of
the cervix, with a reported prevalence of 1.5-
10%
• Clinical presentation
More than half of cases are asymptomatic. Symptoms can
include menorrhagia, postmenopausal bleeding, contact
bleeding, and vaginal discharge. The diagnosis is made
primarily with hysteroscopy.
• Pathology
Histologically, cervical polypoid lesions encompass a
spectrum pathologic entities which include endocervical
or endometrial tissue with metaplasia.
The polyps are usually pedunculated, often with a slender
pedicle of varying length, but some can be sessile.
 Ultrasound

• Sessile or pedunculated well-

circumscribed masses within the
endocervical canal
• may be hypoechoic or echogenic
• identifying the stalk attaching to the
cervical wall helps differentiate it from an
endometrial polyp
Sometimes it may be very difficult to
diagnose endocervical polyps if more
than one are cramping the limited
endocervical canal space, even
with the help of mucous in the
cervical canal, as shown by
the neighbouring image . It shows two
polyps rising from the top part of
the endocervical canal. The main
complaint of this patient was copious
mucoid vaginal discharge,
which showed no pathogens on
repeated high vaginal
and endocervical swabs
 ENDOMETRIAL POLYP
• Endometrial polyps are benign nodular
protrusions of the endometrial surface, and
one of the entities included in a differential
of endometrial thickening. Endometrial polyps
can either be sessile or pedunculated. They
can often be suggested on ultrasound or MRI
studies, but may require sonohysterography or
direct visualisation for confirmation.
Epidemiology
• Most patients are perimenopausal at the time of presentation,
especially in the 5th decade of life. They are the most common mass
lesion of the cervix, with a reported prevalence of 1.5-10%
Clinical presentation
• More than half of cases are asymptomatic. Symptoms can include
menorrhagia, postmenopausal bleeding, contact bleeding, and
vaginal discharge. The diagnosis is made primarily with
hysteroscopy.
Pathology
• Histologically, cervical polypoid lesions encompass a spectrum
pathologic entities which include endocervical or endometrial tissue
with metaplasia.
• The polyps are usually pedunculated, often with a slender pedicle of
varying length, but some can be sessile.
 ULTRASOUND
• Although endometrial polyps may be visualised at transvaginal
ultrasound as non-specific endometrial thickening, they may also be
identified as focal masses within the endometrial canal.
• a stalk to the polyp may either be thin- or broad-based
• a single feeding vessel may be seen extending to the polyp on
colour Doppler imaging
– Visualisation of a vascular pedicle is 76% sensitive and 95% specific for
endometrial polyps
• cystic spaces corresponding to dilated glands filled with
proteinaceous fluid may be seen within the polyp and is considered
a relatively characteristic feature
• may appear as just diffusely thickened endometrium, without
visualisation of a discrete mass (mimicking endometrial hyperplasia)
• The first ultrasound image shows a sagittal view of a
uterus with an echogenic polyp splitting the central
endometrial echo, which is a characteristic of polyps.
• The second image shows a similar view of a uterus with
an intracavitay fibroid pushing the central
endometrial echo to one side rather than splitting it
However, ultrasonic examination may fail to reveal endometrial polyps as they are
usually echogenic and merge with the background echogenicity of the
endometrium. Sometimes they show few anechoic areas due to entrapped
mucous. Each polyp has central blood vessels which may be seen with colour
Doppler mapping, as shown below.

The first double image above shows sagittal and axial views of a uterus with thick echogenic
endometrium, showing sonolucent small areas. It was initially thought to be hyperplastic in
nature.
The second 3D image of the same uterus showed instead multiple fundal polyps.
The third image demonstrated how saline infusion sonohysterography could also be useful.
It revealed multiple posterior wall polyps, in a different patient who had a similarly thick and
echogenic endometrium