Uterine Pathologies, Leiomyomas, Adenomyosis, and Endometrial Diseases — WACS Viva & Clinical Scenarios (Obstetric and Gynaecological Imaging)

Exam-style uterine pathologies, leiomyomas, adenomyosis, and endometrial diseases viva scenarios with examiner probes and model answers for Radiology…

Scenarios covered

• SCENARIO 1: A 34-year-old nulliparous woman presents with severe menorrhagia, dysmenorrhoea, and secondary subfertility. Pelvic ultrasound and magnetic resonance imaging (MRI) reveal multiple uterine masses. Detail the International Federation of Gynecology and Obstetrics (FIGO) leiomyoma subclassification system (Types 0 to 8), describe the multi-modality imaging characteristics of typical versus degenerating fibroids on ultrasound and pelvic MRI, and explain the imaging criteria used to differentiate an atypical leiomyoma from a uterine leiomyosarcoma.
• SCENARIO 2: A 42-year-old multiparous woman presents with progressively worsening dysmenorrhoea and chronic pelvic pain. Transvaginal sonography demonstrates asymmetric myometrial thickening. Detail the Morphological Uterus Sonographic Assessment (MUSA) consensus features for adenomyosis, discuss the specific pelvic MRI diagnostic criteria including junctional zone measurements, and outline the key imaging features that distinguish diffuse and focal adenomyosis from uterine leiomyomas.
• SCENARIO 3: A 58-year-old postmenopausal woman presents with a single episode of vaginal spotting. Explain the transvaginal ultrasound evaluation and thickness thresholds for the postmenopausal endometrium in symptomatic versus asymptomatic patients, discuss the role and findings of saline infusion sonohysterography (SIS) and colour Doppler in distinguishing endometrial polyps from diffuse hyperplasia or carcinoma, and describe the imaging findings of intracavitary fluid collections.
• SCENARIO 4: A 28-year-old woman with a history of vigorous postpartum curettage presents with secondary amenorrhea and subfertility. Describe the imaging findings and severity grading of Asherman syndrome on hysterosalpingography (HSG), saline infusion sonohysterography, and 3D ultrasound, and explain the multiplanar imaging criteria used to differentiate intrauterine synechiae from congenital Mullerian duct anomalies such as a septate or bicornuate uterus.