Adenomyosis after HIFU

Adenomyosis is a difficult disease to treat. Most patients with adenomyosis will present with heavy and painful menses and infertility. There is no good treatment for adenomyosis especially for women who want to conceive. Here I will highlight 2 cases where High intensity focused ultrasound (HIFU) can be used to treat adenomyosis. 

Case 1 is a 23 year old single lady with severe painful menses. Figure 1 shows that she has a large posterior adenomyosis. Figure 2 shows the contrast MRI of the same patient. In this patient HIFU need to be done carefully so as to preserve the endometrial cavity. Her HIFU sonification time was 800 s. Figure 3 is contrast MRI done one day after HIFU. It shows the ablated areas of adenomyosis which appears as darker areas on the contrast MRI.

Case 2 a 47 year old single lady with heavy and painful menses. She is not keen on pregnancy. Figure 4 shows the MRI of the pelvis showing a large adenomyosis with 2 small anterior subserous fibroids. Fig 5 shows contrast MRI before HIFU treatment. Since this patient is not keen on pregnancy, we could do extensive ablation of the adenomyosis. The endometrium was also ablated. Sonication time was1632 s. Figure 6 shows the contrast MRI done one day after the HIFU. Note the large area of ablation and even the endometrium has been ablated. This will give good relief of her symptoms and so she need not have to undergo a hysterectomy.

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