ASHERMAN UTERINE SYNECHIA ARTERY – Case By Dr. Nitin Jadhav

History:

Patient came with the history of amenorrhea and infertility,past history of surgery such as dilation and curettage (D&C).

Ultrasound Findings :

●     The above image is of 2D,3D uterus and transvaginal ultrasound reveals normal sized uterus, but with irregular or obliterated endometrial lining which is the discontinuity in endometrial stripe.

●     Hyperechoic bands traversing the uterine cavity. These bands may cause partial or complete obliteration of the endometrial cavity.

Other findings and description:

●     Endometrial Stripe is thinned or not visualized, often below 2 mm replaced by hyperechoic bands.

●     Failure of uterine distension with saline during a sonohysterogram (Saline Infusion Sonohysterography, SIS) indicates adhesions.

●     Asherman syndrome is diagnosed primarily through imaging findings on ultrasound and clinical symptoms such as amenorrhea or hypomenorrhea following uterine surgery.

Diagnosis:

Asherman syndrome

Differential Diagnosis:

1. Endometrial Atrophy: Can cause thin endometrium, common in postmenopausal women but lacks the intrauterine adhesions seen in Asherman syndrome.

2. Chronic Endometritis: May also present with abnormal endometrial appearance and adhesions but is associated with inflammation and may show fluid collection within the endometrium.

3. Uterine Synechiae: Similar findings but often occurs after cesarean section without a history of intrauterine procedures like D&C.

Discussion:

●     Asherman syndrome is an important consideration in women with a history of intrauterine surgery who present with menstrual irregularities or infertility. Imaging plays a vital role, particularly with saline infusion sonography, which can better demonstrate intrauterine adhesions and endometrial distortion.

●     Severe uterine infections like tuberculosis or endometritis can also lead to adhesions.

●      Prior radiation therapy to the pelvic area can cause intrauterine scarring.

Conclusions:

Ultrasound, especially sonohysterography, is critical in diagnosing Asherman syndrome by revealing endometrial scarring and adhesions. Early diagnosis and treatment, often through hysteroscopic adhesiolysis, can restore normal uterine function and fertility.