Endometriosis differential diagnosis: Difference between revisions

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|Endometriosis
|Endometriosis
|dysmenorrhea and dyspareunia  infertility,
|
 
*Dysmenorrhea
Peak age 25 to 35 years bowel and bladder dysfunction, abnormal uterine bleeding, low back pain
*Dyspareunia
|nodules in the posterior fornix, adnexal masses, and immobility or lateral placement of the cervix or uterus
*Infertility
|Serum cancer antigen (CA) 125 
*Peak age of onset 25 to 35 years of age
Nodules of the rectovaginal septum
|
 
*Nodules in the posterior fornix
Hypoechoic, vascular mass on MRI
*Adnexal masses
 
*Fixed retroverted uterus
Laproscopic visualization
*Lateral displacement of the cervix
|
*IncreasedSerum cancer antigen-125 
*Nodules of the rectovaginal septum and hypoechoic, vascular mass on MRI
*Laproscopic visualization confirms the diagnosis
|-
|-
|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>
|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
|
 
*Abnormal uterine bleeding
40 and 50 
*Dysmenorrhea
*Peak age of onset 40 and 50 years of age
|Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation  
|Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation  
|Asymmetric thickening of the myometrium on MRI
|
*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>
|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  
Menorrhagia  
*Pelvic pressure and pain
 
*Infertility
Pelvic pressure and pain
*Peak age of onset 25 to 44 years of age
 
|
Infertility
*Mobile uterus with an irregular contour
|mobile uterus with an irregular contour
|
|Transvaginal ultrasound will demonstrate the presence of myomas
*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>
|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
|
 
*Seen in patients with history of sexually transmitted disease
multiple sexual partners 
*History of multiple sexual partners 
 
*Common in women younger than 25 years of age
age younger than 25
|
|abdominal tenderness 
*Abdominal tenderness 
 
*Acute cervical motion, uterine, and adnexal tenderness
Acute cervical motion, uterine, and adnexal tenderness
*Visualization of urulent endocervical discharge 
 
|
Purulent endocervical discharge 
*Positive Nucleic acid amplification tests for C. trachomatis and N. gonorrhoeae
|Positive Nucleic acid amplification tests for ''C. trachomatis'' and ''N. gonorrhoeae''
*Gram negative diplococci on gram stain
|-
|-
|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>
|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
*Shifting lower abdominal pain
Cervical motion tenderness
*Deep dyspareunia
|pelvic varicosities on ultrasound with reduced blood flow  
*Post-coital pain
*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 16:05, 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
  • Dyspareunia
  • Infertility
  • Peak age of onset 25 to 35 years of age
  • Nodules in the posterior fornix
  • Adnexal masses
  • Fixed retroverted uterus
  • Lateral displacement of the cervix
  • IncreasedSerum cancer antigen-125 
  • Nodules of the rectovaginal septum and hypoechoic, vascular mass on MRI
  • Laproscopic visualization confirms the diagnosis
Adenomyosis[1]
  • Abnormal uterine bleeding
  • Dysmenorrhea
  • Peak age of onset 40 and 50 years of age
 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]
  • Menorrhagia
  • Pelvic pressure and pain
  • Infertility
  • Peak age of onset 25 to 44 years of age
  • Mobile uterus with an irregular contour
  • Transvaginal ultrasound will demonstrate the presence of myomas
Pelvic Inflammatory disease[3]
  • Seen in patients with history of sexually transmitted disease
  • History of multiple sexual partners 
  • Common in women younger than 25 years of age
  • Abdominal tenderness 
  • Acute cervical motion, uterine, and adnexal tenderness
  • Visualization of urulent endocervical discharge 
  • Positive Nucleic acid amplification tests for C. trachomatis and N. gonorrhoeae
  • Gram negative diplococci on gram stain
Pelvic congestion Syndrome[4]
  • Shifting lower abdominal pain
  • Deep dyspareunia
  • Post-coital pain
  • Exacerbation of pain after prolonged standing 
  • Bimanual tenderness
  • Cervical motion tenderness
  • Pelvic varicosities on ultrasound with reduced blood flow

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
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