Varied Appearances of Chronic Endometritis at Hysteroscopy

Abstract

The purpose of this study is to demonstrate high resolution hysteroscopic images taken in different cases of chronic endometritis. Retrospective analysis of hysteroscopic images. A private hysteroscopic surgery centre. Consecutive cases in which hysteroscopy was indicated between 1993 and 2012. High resolution hysteroscopic images were taken in cases where chronic endometritis was suspected. Such images were later analyzed in greater detail to study and establish morphological features associated with the disease. The diagnosis of the disease was based on histologic and hysteroscopic findings. We observed that at fluid hysteroscopy chronic endometritis was characterized by focal or diffuse hyperemia, superficial vascularisation, edema and micropolyps. The hyperaemic areas contained endometrial glands with a prominent white central point surrounded by hyperaemia. Close up visualization revealed that in some cases endometrial glands were surrounded by independent circular reddish zones while in other cases hyperaemia was diffuse/in appearance/in nature. On rare occasions the hyperaemia presented as single or multiple concentric rings. The stromal edema frequently resulted in an undulating bumpy endometrial surface. In many cases micropolyps could be detected by utilizing 40x at source panoramic visualization and most micropolyps demonstrated independent vascular architecture comprising of afferent efferent vessels. In some cases the micropolyps were translucent while in other cases the micropolyps were opaque to light. All described findings were not necessararily present in each and every case. Chronic endometritis thus exhibited a morphology which varied from case to case. Evaluation of the hysteroscopic images helped us better diagnose chronic endometritis at hysteroscopy. In this presentation we shall show high definition hysteroscopy images related to 30 different cases of chronic endometritis. We believe that these images shall help the viewers to appreciate the varied endometrial appearances observed in chronic endometritis.