Transvaginal examination demonstrates a tissue plane between the uterusand the mass Small fibroids can be difficult to detect sonogra phically They ca use a hete rogeneous echotexture of the myometrium without sonog raphically visible focal lesions. At times, only a contourdistortion a long theinterface between the uterus and bladders seen. Sarcomas comprise less than 5% of uterine malignancies. They resemble fibroids or endometrial caranoma (17) When a rapid change in the size of fibroids is noticed, a uterine sarcoma should be considered as the etiology(Fig. 28-15A and Fig. 28-15B) Figure -28-15a. Uterine sarcoma Transa bdominal view of the uterus in a woman with a recent myomectomy demonstrates an enlarged uterus with a bizarre a ppearance to the myometrium with multiple cystic spaces Fiqure-28-15b CT has a similar appearan Adenomyosis isa cause of heavy painful menses. The condition is produced when nests ofendometrial tissue are located within the myometrium. The sonographic diagnosis is diffcult to make. In general, the uterus is enlarged without focal mass(18, 19)(Fig. 28-16). A times, small blood-conta ining spaces in the uterus can be seen ca used by dilated glands filled with menstrual products gure-28-16 Enlarged uterusin a 53-year-old woman with abnormal bleeding. The uterusis enlarged slightly and heterogeneous in echotexture but has no focal masses. Histologic examination re vealed adenomyosisFigure - 28-8b. Transvaginal examination demonstrates a tissue plane between the uterus and the mass Small fibroids can be difficult to detect sonographically. They cause a heterogeneous echotexture of the myometrium without sonographically visible focal lesions. At times, only a contour distortion along the interface between the uterus and bladder is seen. Uterine Sarcoma Sarcomas comprise less than 5% of uterine malignancies. They resemble fibroids or endometrial carcinoma. (17) When a rapid change in the size of fibroids is noticed, a uterine sarcoma should be considered as the etiology (Fig. 28-15A and Fig. 28-15B ) . Figure - 28-15a. Uterine sarcoma. Transabdominal view of the uterus in a woman with a recent myomectomy demonstrates an enlarged uterus with a bizarre appearance to the myometrium with multiple cystic spaces. Figure - 28-15b. CT has a similar appearance. Adenomyosis Adenomyosis is a cause of heavy painful menses. The condition is produced when nests of endometrial tissue are located within the myometrium. The sonographic diagnosis is difficult to make. In general, the uterus is enlarged without focal mass (18,19) (Fig. 28-16 ) . At times, small blood-containing spaces in the uterus can be seen caused by dilated glands filled with menstrual products. Figure - 28-16. Enlarged uterus in a 53-year-old woman with abnormal bleeding. The uterus is enlarged slightly and heterogeneous in echotexture but has no focal masses. Histologic examination revealed adenomyosis