On transvaginal ultrasound, which finding is MOST specific for adenomyosis?

• A Homogeneous myometrial echogenicity
• B Heterogeneous myometrium with myometrial cysts (Swiss-cheese appearance) ✓
• C Subendometrial echogenic foci with posterior acoustic shadowing
• D Asymmetric myometrial thickening of the posterior wall only

Explanation

Myometrial cysts (anechoic lacunae giving a 'Swiss-cheese' appearance) on transvaginal ultrasound are the most specific sonographic feature of adenomyosis. Other features include heterogeneous myometrial echotexture, subendometrial linear striations, asymmetric myometrial thickening, and ill-defined endometrial-myometrial junction. Subendometrial echogenic foci with shadowing are more typical of endometrial polyps or submucous fibroids.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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