Focal intracavitary masses recognized with the hyperechoic line sign at endovaginal US and characterized with hysterosonography.

In 42 women, endovaginal ultrasonography (US) was performed because of an abnormal central endometrial complex. Retrospective review of the endovaginal US scans and subsequently obtained hysterosonograms with histopathologic correlation showed a hyperechoic line surrounding the central endometrial complex in 25 patients, all of whom had focal intracavitary processes. Cystic spaces within the central endometrial complex in 17 of these patients reflected polyps; this finding was associated with a hyperechoic line in 15. At hysterosonography, all polyps (n = 29) had a narrow attachment to the endometrium. All five fibroids were broadly attached and had a rim of overlying endometrium. These focal abnormalities were easily distinguished from global endometrial processes amenable to a blind biopsy procedure. This initial experience showed that a hyperechoic line circumscribing the central endometrial complex at endovaginal US allows prediction of focal intracavitary disease, particularly when the line is associated with cystic spaces within the central endometrial complex. The presence of a hyperechoic line can be used to direct the patient to a visually guided hysteroscopic procedure rather than a potentially unsuccessful blind biopsy procedure. Alternatively, absence of a hyperechoic line can prompt management appropriately directed by hysterosonographic characterization of the uterine contents as focal or diffuse.