Medical expert of the article
New publications
Ultrasound signs of uterine abnormalities in non-pregnant women
Last reviewed: 03.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Uterine pathology
Myomas (fibromas)
Myomas may be visualized differently on ultrasound. Most of them are defined as multiple, well-defined, homogeneous hypoechoic nodular formations, subserous, submucous or interstitial. Old myomas become hyperechoic, some of them acquire mixed echogenicity as a result of central necrosis. Bright hyperechoic structures may be determined as a result of calcification. A rapidly growing myoma, for example during pregnancy, simulates hypoechoic cysts. It is necessary to examine in different planes to differentiate myoma from tubo-ovarian formation. Some myomas grow on a stalk. Uterine myomas may displace the posterior wall of the urinary bladder.
Myomas may have calydinates, represented by bright hyperechoic structures with a distal shadow. Myomas are almost always multiple and often disrupt the normal contour or displace the uterine cavity.
Myomas can also be localized in the cervix and can displace or cause obstruction of the cervical canal.
Developmental anomalies
A bicornuate uterus can be identified by the presence of two cavities or by identifying one and the other uterine fundus during transverse scanning. Careful scanning is necessary to avoid confusing a bicornuate uterus with ovarian masses. A double uterus has two cavities and two cervixes: if there is an ovarian mass or a mass in another organ, only one uterine cavity and the cervical canal will be identified.
[ Pathology of the endometrium
Normal echotexture varies considerably depending on the stage of the menstrual cycle. In the proliferative phase (early menstrual cycle), the endometrium appears thin and hypoechoic. In the periovulatory phase (mid-cycle), the central part of the endometrium becomes hyperechoic and is surrounded by a hypoechoic rim. With the onset of menstruation, the endometrium becomes completely hyperechoic and thickened due to tissue detachment and the formation of blood clots.
In women with a congenital absence of the hymen opening or in women who have had ritual suturing, blood may accumulate in the uterine cavity (with the development of hematometra) or in the vagina (hematocolpos) and will appear hypoechoic compared to the endometrium.
The uterine cavity may be filled with pus during inflammation (pyometra). Echographically, a hypoechoic zone with an internal echostructure will be determined. Inflammatory exudate may also collect in the fallopian tubes (hydrosalpinx) and spread to the retrouterine space.
Malignant neoplasms
A uterine mass with an unclear outline may be malignant and is more often endometrial cancer. The endometrium thickens, and a hypoechoic tumor may spread to the myometrium. As it progresses, necrosis zones may form with the appearance of a non-uniform echostructure: the uterine cavity expands.
A small cervical carcinoma (cancer) may not always be detected by ultrasound.
Early stages of cervical cancer are very difficult to detect with ultrasound. Any area with an unclear outline in the cervix is suspicious for the presence of a malignant process (most fibroids are clearly defined, and calcification is often detected in them). If the tumor is large, the echostructure is heterogeneous and very variable. The tumor can infiltrate surrounding tissues, and it is necessary to carefully examine the bladder, vagina, and rectum.
Internal endometriosis
Hypoechoic areas in the myometrium near the endometrium may appear due to adenomyosis (endometriosis of the uterus). These areas are visualized more clearly during and immediately after menstruation. Small retention cysts in the cervix located close to the cervical canal should not be mistaken for endometrioid heterotopias. A pelvic mass may be an endometrioma or ectopic pregnancy.
Remember: it is necessary to constantly change the sensitivity level during an ultrasound examination of the pelvic organs to obtain an optimal image.