KEY FACTS
Terminology
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Focal hyperplastic overgrowth of endometrial tissue
Imaging
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Pedunculated or sessile endometrial lesion, solitary or multiple (20%)
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Echogenic lesion during proliferative phase
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May be less conspicuous during secretory phase as entire endometrium is more echogenic
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Variable size: May be tiny or large enough to fill entire uterine cavity
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May prolapse into cervical canal
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Small “cystic” areas due to dilated endometrial glands
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Hyperechoic line sign: Full/partial echogenic rim around area of endometrial thickening highly specific for endocavitary mass
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Color Doppler: Single feeding vessel in stalk
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Saline infusion sonohysterography (SIS): Best technique to differentiate focal from diffuse endometrial thickening
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Schedule US/SIS within first 10 days of menstrual cycle
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3D US shows multiple polyps better than 2D
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Useful during SIS (especially if multiple lesions)
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Top Differential Diagnoses
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Endometrial carcinoma
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Endometrial hyperplasia
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Submucosal fibroid
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Gestational trophoblastic disease
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Retained products of conception
Clinical Issues
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Often asymptomatic
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Abnormal bleeding: Intermenstrual, post coital, post menopausal (up to 30% of postmenopausal bleeding)
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Polyp site/number/diameter do not correlate with symptomatology
Diagnostic Checklist
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Saline infusion sonohysterography for endometrial thickening, particularly if no cysts or feeding vessel on US
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MR/TVS/color Doppler may help to distinguish polyp from carcinoma
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Cancer may coexist with benign disease
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Biopsy required: Benign polyps cannot be differentiated from polyps with atypical hyperplasia
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Beware of endometrial “wrinkles,” which can be mistaken for sessile polyps
Scanning Tips
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Timing of ultrasound and SIS optimizes detection
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Schedule scans early in menstrual cycle in menstruating females
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If postmenopausal not on hormone replacement therapy (HRT), schedule at any time
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If postmenopausal on HRT, schedule immediately after withdrawal bleed
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SIS: Schedule within first 10 days of menstrual cycle in menstruating females
with the hyperechoic line sign 
.
attached to the fundus 
. Notice interrupted mucosa sign at the interface of endometrial stripe and polyp 
, another specific sign of an endometrial polyp.
in the pedicle of the polyp.
, which is broadly attached to the right uterine fundus 
.
displacing the endometrial line 
.
to the endometrial polyp.
, which is attached to the fundus 
. The catheter 
and nabothian cysts 
are noted. The polyp was single.
