OBGY Radiology

Case 17
A 24-year-old female presented with irregular bleeding PV. Patient had a history of MTP (6 weeks size) done 6 months prior to the current bleeding episode. USG was performed. What is the diagnosis?
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Imaging Diagnosis

Findings revealed a dense linear echogenic band in the endometrial cavity with posterior acoustic shadowing. Myometrium and both ovaries were normal.


Endometrial ossification (osseous metaplasia of endometrial tissue)


Osteoid metaplasia of the uterus is a rare disease that affects the uterus and was reported after abortion, in chronic endometrites, metabolic disorders, and electro excision of the cervix (e.g. for severe cervical dysplasia).
Heterotopic tissue in the uterus is rare and unexplainable. It is supposed that remaining fetal bone tissue initiates the procces of osseous metaplasia.
The effects of the heterotopic bone can be compared to those of an IUD so that symptoms such as irregular bleeding, sterility or infertility, repeated early abortions are frequently found in these patients; the symptoms cease only after removal of the bony material from the uterus. After removal of the bony material the patient can develop a normal pregnancy.
It needs to be differentiated from calcification of a necrotic tissue. Some authors consider that it is due to retention of placental fragments or chronic endometritis.
Metabolic disorders like hypercalcemia, hypervitaminosis can also lead to endometrium calcification. Pathogenetic mechanism is not known, but cases have been reported especially after abortion. The period of time between abortion and diagnoses of the disease can vary from several months to 12 years.
Endometrial ossification in postmenopausal women is very rare. Therefore, clinicians should consider the possibility of endometrial ossification as a differential diagnosis of intrauterine foreign body on ultrasound, even in older patients. In addition, pathologists should be aware of this rare entity in order to avoid a misdiagnosis of malignant mixed mullerina tumor in the endometrial curettage specimen, which may result in unnecessary hysterectomy.