Imaging findings differentiating uterine cavity polypoidal masses

• Abnormal uterine bleeding (AUB) has a grave impact on women’s health. Uterine cavity polypoidal masses are a potential cause. • US, along with Doppler, has a crucial role in differentiating these, with the merit of being non-invasive and radiation-free. • MRI is most accurate for preoperative planning. The size, extent, vascular stalk and myometrial invasion can be exactly assessed. • Thus, imaging sets a roadmap for the gynaecologists in the management of uterine cavity polypoidal masses. Uterine leiomyomas uncommonly manifest as submucous pedunculated masses, a few of which are adenomyomas. These must be differentiated from endometrial polyps (EPs) due to their different malignant potential, prognosis and management. We aim to differentiate between these uterine cavity polypoidal masses by illustrating the imaging features on ultrasound (US), Doppler and magnetic resonance imaging (MRI). On US, uterine leiomyomas appear hypoechoic with an overlying layer of echogenic endometrium, distorting the endometrial-myometrial junction with multiple feeding vessels. However, the endometrial polyp appears isoechoic with preservation of the endometrial-myometrial interface and a well-defined single vascular pedicle within the stalk. The presence of cysts with haemorrhage on MRI is a crucial feature of prolapsing adenomyoma. This differentiation is essential for the prompt management of the patients. Imaging helps detect and differentiate uterine submucous pedunculated leiomyomas from adenomyomas and polyps and thus, plays a crucial role in the patient’s therapeutic approach.