Imaging investigation of postmenopausal bleeding

doi:10.1136/bmj.a2787

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Anju Sahdev, consultant radiologist

¹Barts and London NHS Trust, London EC1A 7BE

anju.sahdev{at}bartsandthelondon.nhs.uk

A 72 year old woman presented with a two month history of postmenopausal vaginal bleeding. Relevant medical history included insulin dependent diabetes, hypertension, and recent breast cancer. She had been taking tamoxifen for three years.⇓

Questions

1 What imaging investigation is shown in the picture⇑?
2 What abnormality is shown?
3 In a postmenopausal woman, what conditions produce these appearances?
4 What does the patient need next?

Answers

Short answers

1 Transvaginal ultrasound scan of the uterus⇓.

Fig 1 Transvaginal ultrasound shows endometrial thickening measuring 1 cm.

2 Endometrial thickening measuring 1 cm. An acceptable postmenopausal endometrial thickness should be less than 5 mm.
3 Benign endometrial polyps, endometrial hyperplasia, endometrial cancer.
4 The patient requires referral to a cancer centre or unit for full gynaecological evaluation and endometrial sampling to establish the nature of the endometrial thickening.