Endometriosis differential diagnosis: Difference between revisions
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!Clinical Features | !Clinical Features | ||
!Physical Examination | |||
!Diagnostic Findings | !Diagnostic Findings | ||
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|dysmenorrhea and dyspareunia infertility, | |dysmenorrhea and dyspareunia infertility, | ||
Peak age 25 to 35 years | Peak age 25 to 35 years bowel and bladder dysfunction, abnormal uterine bleeding, low back pain | ||
| | |nodules in the posterior fornix, adnexal masses, and immobility or lateral placement of the cervix or uterus | ||
|Serum cancer antigen (CA) 125 | |||
Nodules of the rectovaginal septum | |||
Hypoechoic, vascular mass on MRI | |||
Laproscopic visualization | |||
|- | |- | ||
|Adenomyosis | |Adenomyosis<ref name="pmid16782099">{{cite journal| author=Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P| title=Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. | journal=Fertil Steril | year= 2006 | volume= 86 | issue= 3 | pages= 711-5 | pmid=16782099 | doi=10.1016/j.fertnstert.2006.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782099 }}</ref> | ||
| | |Abnormal uterine bleeding and dysmenorrhea | ||
| | |||
40 and 50 | |||
|Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation | |||
|Asymmetric thickening of the myometrium on MRI | |||
|- | |- | ||
| | |Submucous uterine leiomyomas<ref name="pmid26477496">{{cite journal| author=Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J et al.| title=Long-term medical management of uterine fibroids with ulipristal acetate. | journal=Fertil Steril | year= 2016 | volume= 105 | issue= 1 | pages= 165-173.e4 | pmid=26477496 | doi=10.1016/j.fertnstert.2015.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26477496 }}</ref> | ||
| | |25 to 44 years of age | ||
| | |||
Menorrhagia | |||
Pelvic pressure and pain | |||
Infertility | |||
|mobile uterus with an irregular contour | |||
|Transvaginal ultrasound will demonstrate the presence of myomas | |||
|- | |- | ||
| | |Pelvic Inflammatory disease<ref name="pmid24216035">{{cite journal| author=Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections| title=2012 European guideline for the management of pelvic inflammatory disease. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 1 | pages= 1-7 | pmid=24216035 | doi=10.1177/0956462413498714 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24216035 }}</ref> | ||
|prevalence in patients with sexually transmitted disease | |||
| | multiple sexual partners | ||
age younger than 25 | |||
|abdominal tenderness | |||
| | |||
Acute cervical motion, uterine, and adnexal tenderness | |||
Purulent endocervical discharge | |||
|Positive Nucleic acid amplification tests for ''C. trachomatis'' and ''N. gonorrhoeae'' | |||
|- | |- | ||
|Pelvic | |Pelvic congestion Syndrome<ref name="pmid11133549">{{cite journal| author=Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES| title=Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. | journal=AJR Am J Roentgenol | year= 2001 | volume= 176 | issue= 1 | pages= 119-22 | pmid=11133549 | doi=10.2214/ajr.176.1.1760119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11133549 }}</ref> | ||
| | |shifting location of pain, deep dyspareunia, post-coital pain, and exacerbation of pain after prolonged standing | ||
| | |Bimanual tenderness | ||
Cervical motion tenderness | |||
|pelvic varicosities on ultrasound with reduced blood flow | |||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 15:59, 16 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Differential Diagnosis
Endometriosis is a cause of abnormal uterine bleeding and can result in infertility. There are several diseases which can result in excessive uterine bleeding and the following table is a description of various causes of excessive uterine bleeding.
| Clinical Features | Physical Examination | Diagnostic Findings | |
|---|---|---|---|
| Endometriosis | dysmenorrhea and dyspareunia infertility,
Peak age 25 to 35 years bowel and bladder dysfunction, abnormal uterine bleeding, low back pain |
nodules in the posterior fornix, adnexal masses, and immobility or lateral placement of the cervix or uterus | Serum cancer antigen (CA) 125
Nodules of the rectovaginal septum Hypoechoic, vascular mass on MRI Laproscopic visualization |
| Adenomyosis[1] | Abnormal uterine bleeding and dysmenorrhea
40 and 50 |
Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation | Asymmetric thickening of the myometrium on MRI |
| Submucous uterine leiomyomas[2] | 25 to 44 years of age
Menorrhagia Pelvic pressure and pain Infertility |
mobile uterus with an irregular contour | Transvaginal ultrasound will demonstrate the presence of myomas |
| Pelvic Inflammatory disease[3] | prevalence in patients with sexually transmitted disease
multiple sexual partners age younger than 25 |
abdominal tenderness
Acute cervical motion, uterine, and adnexal tenderness Purulent endocervical discharge |
Positive Nucleic acid amplification tests for C. trachomatis and N. gonorrhoeae |
| Pelvic congestion Syndrome[4] | shifting location of pain, deep dyspareunia, post-coital pain, and exacerbation of pain after prolonged standing | Bimanual tenderness
Cervical motion tenderness |
pelvic varicosities on ultrasound with reduced blood flow |
References
- ↑ Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P (2006). "Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis". Fertil Steril. 86 (3): 711–5. doi:10.1016/j.fertnstert.2006.01.030. PMID 16782099.
- ↑ Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J; et al. (2016). "Long-term medical management of uterine fibroids with ulipristal acetate". Fertil Steril. 105 (1): 165–173.e4. doi:10.1016/j.fertnstert.2015.09.032. PMID 26477496.
- ↑ Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections (2014). "2012 European guideline for the management of pelvic inflammatory disease". Int J STD AIDS. 25 (1): 1–7. doi:10.1177/0956462413498714. PMID 24216035.
- ↑ Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES (2001). "Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women". AJR Am J Roentgenol. 176 (1): 119–22. doi:10.2214/ajr.176.1.1760119. PMID 11133549.