ScholarWorks @ SeattleU (Seattle University)

Editors of Fragments

Fragments 
Volume 62 Interlude Article 33 
2020 
Colophon 
Editors of Fragments 
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Available at: https://scholarworks.seattleu.edu/fragments/vol62/iss1/33 
This Magazine Colophon is brought to you for free and open access by ScholarWorks @ SeattleU. It has been 
accepted for inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
 
 
COLOPHON 
Issue No. 62 
INTERLUDE 
 
 
When selecting the theme for this year’s edition of Fragments, we had no idea how relevant 
explorations of interlude would be at the time of publication. We find ourselves collectively in a 
period of transition, of disruption, where nothing is certain but the sound of our own voices 
calling out for one another to hear. We hope that you can find solace, inspiration, or a little peace 
in these pages.   
 
On behalf of our staff, we would like to thank everyone who submitted, and all those who support 
our magazine in any capacity. We quite literally could not do this without you. Special thanks to 
the Seattle University departments that make Fragments financially possible: the Office of the 
Provost, the Dean of Arts & Sciences, the English Department, and the Creative Writing Program.   
 
Thank you for taking time in your own moments of interlude to engage with ours. 
 
In gratitude and solidarity, 
Fragments 
 
Editors in Chief 
Alison Kaitcer 
Shelby J. Leone 
Luke Skinner 
 
 
Design 
Luke Skinner 
 
Editorial Staff 
Mariel Campoverde 
Margery Carlos 
Andrea Fox 
Will Gauthier 
Grace Hoglund 
Annika Le 
Camille Thompson 
Danielle Vanpoucke 
 
Faculty Advisor 
Juan Carlos Reyes 
 
 
 
1
: Colophon
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English

Colophon

Silverman, Madeline McNamara

Fragments 
Volume 63 Pivot Article 27 
2021 
Bibliomancy 
Madeline McNamara Silverman 
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Recommended Citation 
Silverman, Madeline McNamara (2021) "Bibliomancy," Fragments: Vol. 63, Article 27. 
Available at: https://scholarworks.seattleu.edu/fragments/vol63/iss1/27 
This Poetry is brought to you for free and open access by ScholarWorks @ SeattleU. It has been accepted for 
inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
Bibliomancy, Curated, 2020-21 
Madeline McNamara Silverman 
 
 
 
my body didn’t get to 
say goodbye 
go home 
I want to find truer words that 
still have 
resonance 
how do I survive 
the freefall 
igniting  all  of  my  body   memories 
go home 
expand my definition 
freefall 
safety 
I want to 
forgive 
    my 
          dancing body 
perfect in its own right 
go home 
the pain I’ve known 
      go home 
  hasn’t tarnished 
           my goodness 
I want to know 
   that I am on my side 
how do I survive 
the 
free 
fall 
the see-through 
I have a lot 
banging around inside 
I don’t know how to forgive 
my dancing body 
the rage the hurt the sadness the clarity 
the 
free 
fall 
mine mine  mine mine mine   mine    mine mine mine. 
1
Silverman: Bibliomancy
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Bibliomancy

Cruickshank, Keira

Fragments 
Volume 63 Pivot Article 40 
2021 
Is it safe here anymore? 
Keira Cruickshank 
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Recommended Citation 
Cruickshank, Keira (2021) "Is it safe here anymore?," Fragments: Vol. 63, Article 40. 
Available at: https://scholarworks.seattleu.edu/fragments/vol63/iss1/40 
This Visual Art is brought to you for free and open access by ScholarWorks @ SeattleU. It has been accepted for 
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Is it safe here anymore? 
Keira Cruickshank 
 
 
 
 
1
Cruickshank: Is it safe here anymore?
Published by ScholarWorks @ SeattleU, 2021


Is it safe here anymore?

Jondonovan, Pia

Fragments 
Volume 63 Pivot Article 46 
2021 
two deaths 
Pia Jondonovan 
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This Visual Art is brought to you for free and open access by ScholarWorks @ SeattleU. It has been accepted for 
inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
Pia Jondonovan 
study of an edward hopper etching 
 
  
1
Jondonovan: two deaths
Published by ScholarWorks @ SeattleU, 2021
study of steven boksenbaum’s “maria seated” 
 
2
Fragments, Vol. 63 [2021], Art. 46
https://scholarworks.seattleu.edu/fragments/vol63/iss1/46
two deaths 
 
3
Jondonovan: two deaths
Published by ScholarWorks @ SeattleU, 2021


two deaths

Fragments 
Volume 63 Pivot Article 45 
2021 
study of steven boksenbaum's "maria seated" 
Pia Jondonovan 
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Recommended Citation 
Jondonovan, Pia (2021) "study of steven boksenbaum's "maria seated"," Fragments: Vol. 63, Article 45. 
Available at: https://scholarworks.seattleu.edu/fragments/vol63/iss1/45 
This Visual Art is brought to you for free and open access by ScholarWorks @ SeattleU. It has been accepted for 
inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
Pia Jondonovan 
study of an edward hopper etching 
 
  
1
Jondonovan: study of steven boksenbaum's "maria seated"
Published by ScholarWorks @ SeattleU, 2021
study of steven boksenbaum’s “maria seated” 
 
2
Fragments, Vol. 63 [2021], Art. 45
https://scholarworks.seattleu.edu/fragments/vol63/iss1/45
two deaths 
 
3
Jondonovan: study of steven boksenbaum's "maria seated"
Published by ScholarWorks @ SeattleU, 2021


study of steven boksenbaum\u27s  maria seated

Modica, Sophia

Fragments 
Volume 66 Parallel Article 8 
2024 
Withering 
Sophia Modica 
Follow this and additional works at: https://scholarworks.seattleu.edu/fragments 
Recommended Citation 
Modica, Sophia (2024) "Withering," Fragments: Vol. 66, Article 8. 
Available at: https://scholarworks.seattleu.edu/fragments/vol66/iss1/8 
This Poetry is brought to you for free and open access by the Seattle University Journals at ScholarWorks @ 
SeattleU. It has been accepted for inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
Withering by Sophia Modica 
In the basement 
My grandfather offers me 
Nana's muumuus 
Printed with hibiscus flowers 
They smell, like stale plastic 
From the discolored bin they are kept in 
I accept 
One step closer to her 
My grandfather tells me a story 
About his grandmother's funeral 
About uncles playing large drums 
Sticky when slapped from humidity 
Hair slicked back, dark like wet charcoal 
Her brothers beating leather 
With their hands 
While his aunties danced, 
And she was celebrated 
He asks me, 
If I want to see my great great 
grandfather 
Walks to a pile of photos 
Pulls out, my drawing from kindergarten 
Stick figure, 
Depiction unknown 
From beneath, lifts a bulky frame 
A faded 5x7 photo 
My great great grandfather, 
His depiction 
To me, 
Unknown 
I did not ask his name 
My grandfather tells my mother 
Not to speak Spanish 
I fail high school Spanish 
Stumbling over pronunciations 
An earthquake of shame erupting 
On the inside of my throat 
My ancestors, 
Don't understand my speech 
I am given my father's last name 
So that every trace of history 
Is undetectable from the surface 
When I ask my grandfather 
Where we came from 
He doesn't reply to my message, 
At least in no direct answer 
My aunt tells my mother 
"If we had been born in this year 
We would be proud" 
Of being Puerto Rican 
Turns to the backseat of the car, 
Tells me the lineage rests in my hands 
I think of how my children 
(who I may not have) 
Won't hold our history 
As I can barely grasp it 
Making sense of only fragments 
Pieced together 
As my grandfather 
Withers 
And with him 
We wither 
The Man in the Alley by Emma Caplinger 
I saw him before the sun did— 
his wide face stubbled and dew-chilled, 
still and sitting against the damp concrete. 
He looked so much like my brother: 
his dark hair stuck to his forehead, 
broad nose freckled and pale. 
I stopped to watch him 
and was watching still when I saw them coming, 
flashing red against the rain-blue morning. 
When they heaved him onto their cart 
and secured his legs to the stretcher, 
his icy, nowhere-gazing eyes matched the sky. 
And as they pulled the zipper shut, 
I thought of calling home. 
Enco un ter/selfby Fern Creson 


Withering

Robinson, Fox

Fragments 
Volume 66 Parallel Article 17 
2024 
Skin Red Like Fruit 
Fox Robinson 
Follow this and additional works at: https://scholarworks.seattleu.edu/fragments 
Recommended Citation 
Robinson, Fox (2024) "Skin Red Like Fruit," Fragments: Vol. 66, Article 17. 
Available at: https://scholarworks.seattleu.edu/fragments/vol66/iss1/17 
This Poetry is brought to you for free and open access by the Seattle University Journals at ScholarWorks @ 
SeattleU. It has been accepted for inclusion in Fragments by an authorized editor of ScholarWorks @ SeattleU. 
Skin Red Like Fruit by Fox Robinson 
Fingers entwined, 
Tightly clasped - digging. 
Rock picked raw 
Drilling. 
What are you getting out of it? 
Tearing at my skin 
In the shower 
Skin red like fruit 
Not quite high enough. 
Carve your name 
In bark 
Empty your pockets 
Into my mouth 
Tell me your stories 
And expect me to swallow. 
Shedding layers 
Burning and used. 
Plug my ears 
So I don't hear the sounds. 
Branded body - scorched soil 
Flower buds are closing. 
Go back under 
It's not safe up here. 
Utterances grinding 
Whispering: 
Mother is dying. 
Close(d) byJames Miller 
not enough seats 
we squeezein 
bus doors opening, 
like praying mantis legs, 
closing, we are soclose 
we're touchingclothing 
still not enough space 
my face your face 
bus doors opening, 
closing, you'd never let 
me get thisclose 
I breathe slow 
try not to show 
if you were blind 
I'd stare at you more 
f i n a l l y ,  v a c a n c y  
you nudge my elbow 
I go 
slow 
bus doors opening, 
Ihopeyoudon'tnotice 
I'm disappointed 
but I'm going, 
closing 
Why does this feel familiar? 


Skin Red Like Fruit

Pham, Lena

Seattle University 
ScholarWorks @ SeattleU 
Bachelor of Science in Diagnostic Ultrasound 
Projects College of Nursing 
6-1-2025 
Case Study: Left Ventricular Thrombus 
Lena Pham 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/dius-projects 
Recommended Citation 
Pham, Lena, "Case Study: Left Ventricular Thrombus" (2025). Bachelor of Science in Diagnostic 
Ultrasound Projects. 21. 
https://scholarworks.seattleu.edu/dius-projects/21 
This Article is brought to you for free and open access by the College of Nursing at ScholarWorks @ SeattleU. It 
has been accepted for inclusion in Bachelor of Science in Diagnostic Ultrasound Projects by an authorized 
administrator of ScholarWorks @ SeattleU. 
Case Study: Left 
Ventricular Thrombus 
 
 
Lena Pham 
 
 
Abstract 
Left ventricular (LV) thrombus is a 
serious complication often seen in 
patients with significant left 
ventricular dysfunction, ischemic 
cardiomyopathy or prior cardiac 
procedures2. It can lead to 
life-threatening embolic events if not 
promptly diagnosed and managed. 
Patients typically present with 
symptoms such as chest pain, 
shortness of breath, and fatigue, which 
can overlap with other cardiovascular 
conditions, making early detection 
crucial. Echocardiography plays a key 
role in identifying LV thrombus, 
especially when accompanied by 
severe wall motion abnormalities and 
diastolic dysfunction8. Anticoagulation 
remains the cornerstone of treatment, 
aimed at preventing systemic 
embolization and promoting thrombus 
resolution1. However, management 
must be carefully tailored based on 
bleeding risk and overall cardiac 
function. Regular follow-up imaging is 
essential to assess response to therapy 
and guide long-term anticoagulation 
strategies2. This case emphasizes the 
need for early recognition and 
individualized treatment to optimize 
patient outcomes and reduce 
complications associated with LV 
thrombus. 
 
Keywords  
Left Ventricular Thrombus; Ischemic 
Cardiomyopathy; Anticoagulants; 
Apixaban; LV thrombus post CABG 
Introduction 
A left ventricular thrombus (LVT) is a 
blood clot that forms within the left 
ventricle of the heart, most commonly 
after a large myocardial infarction 
(heart attack) or in the setting of 
notably reduced left ventricular 
function. When a thrombus develops 
in the left ventricle, it can impair the 
heart’s ability to pump effectively and 
may pose a serious risk for systemic 
embolization. This includes a stroke, if 
the clot dislodges and travels through 
the arterial system. LVT formation is 
particularly concerning in patients 
with underlying cardiac disease, as it 
reflects stagnant or turbulent blood 
flow within a compromised chamber. 
In this case, we are presented with a 
77-year-old male with a cardiovascular 
history, including coronary artery 
disease (CAD), prior coronary artery 
bypass grafting (CABG), percutaneous 
coronary intervention (PCI), 
hypertension (HTN), and atrial flutter. 
He reported symptoms of chest pain, 
shortness of breath (SOB), poor 
appetite, and dyspnea, which may be 
worsened by reduced cardiac output or 
embolic events associated with the 
thrombus. The combination of prior 
ischemic injury and arrhythmia 
increases the risk of thrombus 
formation due to reduced contractility 
and blood stasis2. Prompt diagnosis, 
often via echocardiography, and 
initiation of anticoagulation are critical 
to prevent complications and improve 
outcomes in such high-risk patients1.  
The patient had a prior 
echocardiogram in 2023 that showed a 
normal-sized left ventricle with mild 
concentric hypertrophy and a 
preserved ejection fraction (EF) of 50%. 
There was some regional wall motion 
abnormality (RWMA), specifically 
hypokinesis of the inferior wall, and 
evidence of grade I diastolic 
dysfunction. However, a more recent 
echocardiogram revealed a noticeable 
decline in cardiac function. The EF 
dropped to 30%, and multiple areas of 
hypokinesis were seen, indicating 
widespread RWMA.  
Figure 1 and Figure 2 shows a 
comparison of a parasternal short axis 
view at the level of the papillary 
muscles. This view is obtained to 
observe the function of the left 
ventricle in a cross-sectional plane. 
Allowing for the assessment of RWMA. 
The comparison shows the importance 
of scanning a patient, looking for 
different windows or acoustic 
pathways in order to obtain the best 
image possible. Sweeping is another 
technique that is crucial in 
echocardiography as it helps visualize 
a structure in multiple different 
planes.  
 
Figure 1. 
Shows a 
Parasternal 
Short Axis at 
the level of the 
Papillary 
Muscles 
 
 
Figure 2. PSAX 
at the level of 
the Papillary 
Muscles with 
thrombus 
(check multiple 
windows) 
 
 
Figure 3. Left 
Ventricular 
Thrombus in the 
Apical 4 Chamber 
view 
 
 
 
Figure 4. LVT in 
the Apical 2 
Chamber view 
 
 
For Figure 3, 4, and 5, it shows the left 
ventricular thrombus in different 
views. Offering cardiologists to see 
where exactly the clot is forming. This 
helps with accuracy of the 
echocardiogram, aiding in diagnosis 
and avoiding any misinterpretations 
that could arise. This 2.7 x 2.7 mobile 
thrombus can be seen measured in 
Figure 8. Some more findings in this 
case were that the diastolic function 
had also worsened, now showing grade 
II dysfunction. And several RMWA's 
are still present. 
 
 
Figure 5. LVT in the 
Apical 3 Chamber 
view 
 
In patients with regional wall motion 
abnormalities (RWMA), reduced 
ejection fraction (EF), and concern for 
thrombus, the use of contrast agents 
like Definity becomes critically 
important in echocardiographic 
evaluation2. RWMA and low EF often 
result in poor endocardial border 
definition, particularly in the left 
ventricular apex — the most common 
site for thrombus formation. This 
makes it challenging to accurately 
assess wall motion and identify 
potential thrombi using standard 2D 
imaging alone2.  
Definity, a microbubble contrast agent, 
enhances the visualization of the 
endocardial borders by improving the 
contrast between the blood pool and 
the myocardium2. This allows for more 
confident evaluation of ventricular 
function and more accurate detection 
or exclusion of a thrombus. Early and 
accurate identification of thrombus is 
essential in these patients due to the 
high risk of embolic events such as 
stroke3.  
Therefore, in cases of RWMA and 
severely reduced EF, especially when 
thrombus is suspected, the use of 
contrast significantly improves 
diagnostic accuracy, risk stratification, 
and guides appropriate management, 
such as anticoagulation therapy2. 
Figures 6 and 7 show the contrast to 
clearly see the LVT and determine the 
Ejection Fraction better.  
Figure 6. 
LVT with use 
of Definity/ 
Contrast in 
Apical 4 
Chamber 
view 
 
Figure 7. 
LVT with use 
of Definity/ 
Contrast in 
Apical 2 
Chamber 
view 
 
 
 
 
Figure 8. 
Measuring the 
LVT size 
 
 
 
Discussion 
In cases where a left ventricular 
thrombus is suspected, multiple 
imaging modalities such as 
contrast-enhanced echocardiography, 
cardiac MRI, or CT may be used to 
better visualize and confirm the 
presence of thrombus3. Accurate 
detection is crucial, as an untreated 
thrombus can enlarge or embolize, 
leading to serious complications like 
stroke3. To prevent this, 
anticoagulation therapy is 
initiated—often starting with 
intravenous heparin in the hospital for 
rapid effect. Once stabilized, patients 
are commonly transitioned to oral 
anticoagulants like Apixaban (Eliquis) 
for long-term management to reduce 
the risk of thrombus progression or 
embolization1. 
 
Conclusion 
In conclusion, accurate identification 
and management of a left ventricular 
thrombus (LVT) requires a 
comprehensive approach involving 
imaging, treatment, and patient 
education. It is essential to obtain all 
possible echocardiographic views to 
ensure proper visualization and avoid 
missing thrombus that may be 
position-dependent. Advanced imaging 
techniques and contrast agents can 
further confirm the diagnosis. 
Common causes of LVT include 
ischemic cardiomyopathy, 
post-myocardial infarction changes, or 
post-CABG complications, particularly 
in the setting of reduced ejection 
fraction and regional wall motion 
abnormalities4. Treatment typically 
begins with anticoagulation, such as 
heparin, followed by a transition to a 
long-term regimen like Apixaban 
(Eliquis). Patient adherence to daily 
medication is critical—ensuring they 
take the correct dosage on time not 
only enhances outcomes but also 
prevents potentially life-threatening 
embolic events5. By combining 
thorough imaging, appropriate 
therapy, and patient-centered care, we 
can significantly improve prognosis 
and quality of life in individuals 
affected by LVT. 
 
In certain cases, fibrinolytic therapy 
may be used to quickly dissolve an LV 
thrombus, though it carries bleeding 
risks6. Surgical resection is another 
option for large or persistent thrombi, 
especially if other cardiac surgery is 
planned6. These are considered when 
anticoagulation alone is not effective 
or appropriate7. 
 
 
 
Ethical Statements 
Ethics Approval:  
Ethical approval was not sought for the 
present study because it did not 
involve altering the patient’s 
healthcare plan.  
 
Informed Consent:  
Informed consent was not sought for 
the present study because all case data 
was de-identified and/or aggregated 
and followed ethics committee or IRB 
guidelines (also referred to as the 
Honest Broker System).  
 
Declaration of Conflicting Interests: 
The author(s) declare(s) that there are 
no conflicts of interest with respect to 
the research, authorship, and/or 
publication of the article.  
 
Funding:  
The author(s) received no financial 
support for the research, authorship, 
and/or publication of this article. 
 
References 
1. Byon W, Garonzik S, Boyd RA, 
Frost CE. Apixaban: a clinical 
pharmacokinetic and 
pharmacodynamic review. Clin 
Pharmacokinet. 2019;58(10):1265-1279. 
doi:10.1007/s40262-019-00775-z  
 
2. Levine GN, McEvoy JW, Fang 
JC, et al. Management of patients at 
risk for and with left ventricular 
thrombus: a scientific statement from 
the American Heart Association. 
Circulation. 2022;146(15). 
doi:10.1161/CIR.0000000000001092 
 
3. Phuah YZ, Tan YX, Zaghloul S, 
et al. A systematic review and 
meta-analysis of transthoracic 
echocardiogram versus cardiac 
magnetic resonance imaging for the 
detection of left ventricular thrombus. 
Eur Heart J Imaging Methods Pract. 
2023;1(2). doi:10.1093/ehjimp/qyad041 
 
4. Allard L, Bernhard B, 
Windecker S, Valgimigli M, Gräni C. 
Left ventricular thrombus in ischaemic 
heart disease: diagnosis, treatment and 
gaps of knowledge. Eur Heart J Qual 
Care Clin Outcomes. Published online 
December 20, 2021. 
doi:10.1093/ehjqcco/qcab097 
 
5. Mehana EM, Shawky AM, 
Abdelrahman HS. Insights on the left 
ventricular thrombus in patients with 
ischemic dilated cardiomyopathy. 
Egypt J Radiol Nucl Med. 2021;52(1). 
doi:10.1186/s43055-021-00628-5 
 
6. Pasli S, Kamler M, Malik R, 
Easo J. Complicated massive left 
ventricular thrombus and surgical 
treatment. Am J Case Rep. 2022;23. 
doi:10.12659/ajcr.937341 
 
7. Machii Y, Hayashi Y, Harada A, 
Ezawa Y, Tanaka M. A rare case of 
early left ventricular thrombus 
development after off-pump coronary 
artery bypass grafting for unstable 
angina pectoris with reduced left 
ventricular ejection fraction. 
Cureus. Published online December 1, 
2024. doi:10.7759/cureus.74938 
 
 
8. Huang L, Zhao X, Wang J, et al. 
 Clinical profile, treatment, and 
prognosis of left ventricular thrombus 
in dilated cardiomyopathy.  
Clin Appl Thromb Hemost. 
2023;29:10760296231179683. 
doi:10.1177/10760296231179683 
 
 


Case Study: Left Ventricular Thrombus

Chan, Vanessa

Seattle University 
ScholarWorks @ SeattleU 
Bachelor of Science in Diagnostic Ultrasound 
Projects College of Nursing 
6-1-2025 
Endometrial Carcinoma: A Case Study 
Vanessa Chan 
Seattle University 
Follow this and additional works at: https://scholarworks.seattleu.edu/dius-projects 
Recommended Citation 
Chan, Vanessa, "Endometrial Carcinoma: A Case Study" (2025). Bachelor of Science in Diagnostic 
Ultrasound Projects. 24. 
https://scholarworks.seattleu.edu/dius-projects/24 
This Article is brought to you for free and open access by the College of Nursing at ScholarWorks @ SeattleU. It 
has been accepted for inclusion in Bachelor of Science in Diagnostic Ultrasound Projects by an authorized 
administrator of ScholarWorks @ SeattleU. 
 
Case Study 
 
Endometrial Carcinoma: A Case Study 
Vanessa Chan 
B.S Diagnostic Ultrasound | Class of 2025 
 
 
 
Abstract 
 
Endometrial Carcinoma is the most common diagnosed gynecology cancer in the United States, 
specifically the population of white women in their early 60’s, typically looking at postmenopausal 
women. This case study looks into a 49-year-old female patient during an internet outage who is 
experiencing symptoms that lead towards a hysterectomy through ultrasound examinations 
transabdominally and transvaginally which evaluates the uterus, ovaries, and adnexa all in two planes 
(Transverse and Sagittal). Ultrasound findings showed a fibroid and a suspicious endometrium. This study 
also highlights the importance of timely patient care, and patient privacy.  
 
Keywords 
Gynecology, Endometrium, Endometrial Neoplasm, Estrogen, Postmenopause 
 
 
Introduction 
 
 
Endometrial Carcinoma is a type of cancer that 
originates from the endometrium, the inner 
lining of the uterus. This is the most common 
malignancy of the female reproductive organ, 
primarily affecting postmenopausal women. The 
most common clinical symptoms manifest as 
abnormal uterine bleeding, postmenopausal 
bleeding, pelvic pain, or weight loss.  
 
 
Case Report 
 
The case study patient was a 49-year-old female 
who presented to an outpatient clinic during an 
internet outage, with abnormal uterine bleeding 
between menses for 3 months. Her last 
menstrual period (LMP) was unknown due to 
the vaginal bleeding, however she is 
perimenopausal. She is taking bioidentical 
hormone replacements. A transabdominal and 
transvaginal exam was performed. The patient 
had a prior exam done in 2019 and resulted in a 
finding of a fibroid. During our exam, the 
endometrium appeared thickened and 
heterogeneous, concerning for endometrial 
carcinoma. A follow-up tissue sampling, and 
close-up ultrasound was then suggested. 
Alongside prognosis, an important factor we 
must consider is health equity. During this study, 
there was a loss of internet. It’s certainly 
important to research the patient’s history 
beforehand in order to ensure care of our best 
possible abilities. Delays in accessing patient 
prior data can influence decision making. We 
must consider patient-perspective during our 
practice. Many factors for timely care can affect 
patient care outcome and prognosis. 
Chan                                                                                                                                                               2 
 
 
Figure 1. Prior from 2019. Sagittal view of the 
endometrial stripe. Within normal limits (under 4mm) 
 
 
Figure 2. Prior from 2019. Uterus fibroid. Posterior 
intramural uterus. Two planes 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 3. Posterior Intramural fibroids, 
corresponding to  prior 
Discussion 
 
Sonographically, we found the myometrium to 
be heterogeneous, with a single fibroid posterior 
to the midline uterine body and intramural. 
Measurements of the fibroid corresponded to 
their prior finding of about 1.5cm in 
three-dimensions, re-presenting no growth from 
a 6 year follow-up. The endometrium appears 
thickened, heterogeneous, and ill-defined. The 
endometrial stripe measured 1.2cm -3.1cm, 
raising suspicion. The cervix included nabothian 
cysts which are common benign, mucous-filled 
cysts that appear on the surface of the cervix 
caused by mucous retention. Conversely, a 
normal uterus appears to have a homogeneous 
texture with a smooth contour. A normal 
endometrium thickness will vary depending on 
the stage of menstrual cycle. For 
postmenopausal women, endometrial thickness 
is typically under 4mm, however this patient is 
perimenopausal. As represented, fibroids will 
appear focal, and heterogeneous. Ultrasound is 
operator dependent and is typically the first 
choice of imaging due to cost effectiveness. 
Other imaging modalities that could be 
considered is a CT scan. It can have a more 
accurate representation of location.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chan                                                                                                                                                               3 
 
 
 
 
Figure 4. Sagittal image of endometrial stripe 
measuring 2.8cm 
 
 
 
Figure 5. Sagittal image of endometrial stripe 
measuring 1.2cm 
 
 
 
 
Figure 5. Transverse image of endometrial stripe 
measuring 3.1 cm 
 
 
 
 
 
 
Figure 6. Transverse image of endometrial stripe 
measuring 3.1cm 
 
 
 
 
 
 
 
Studies have shown that “there has been a 
28.6% increase in the incidence of early-onset 
(younger than 50 years old) endometrial cancer” 
(Adekambi, 2024).  
 
 
Endometrial carcinoma is categorized into two 
main types. Type I (Endometrioid 
Adenocarcinoma) which is estrogen-dependent 
and associated with endometrial hyperplasia; a 
thickening of the endometrium. This is the most 
common type. The progression appears 
slow-growing and is less likely to spread. Type 
II (Non-Endometrioid) is less common, but more 
aggressive, including serous fluid, and not 
linked to excess estrogen. This progression 
appears to be more aggressive and can spread to 
other parts of the uterus and exterior to the 
uterus. Some risk factors include exposure to 
hormone replacement therapy, specifically 
estrogen, late menopause, or polycystic ovarian 
syndrome.  
A study done reported a common trend that 68% 
of women with early endometrial cancer had a 
high body mass index (BMI). Alongside, it used 
to be only known to postmenopausal women, 
but now more premenopausal women are being 
diagnosed with it. A high BMI may factor into 
this. However, it is still primarily seen in post 
menopausal women.  
Another study done between 2005-2020 
included a total of 569,817 patients diagnosed 
with endometrial carcinoma, 11.6% were 
younger than 50-years-old which mostly 
consisted of white women in their early 60’s. 
 
 
Conclusion 
 
This study was a unique case of endometrial 
carcinoma, emphasizing the importance of 
timely care. Transabdominal and Transvaginal 
exams played a crucial role in the prognosis of 
Chan                                                                                                                                                               4 
 
 
identifying endometrial cancer while 
considering the clinical symptoms in 
correspondence. A radiologist confirmed the 
thickened and heterogeneous endometrium, 
measuring 2.8cm concerning for endometrial 
cancer. Tissue sampling and a close follow-up 
ultrasound was suggested, and possibly a 
hysterectomy. A hysterectomy is a surgical 
procedure to remove the uterus when 
abnormalities arise to prevent it from spreading. 
In this case, a dilation and curettage (D&C) 
would be the next step. This is a surgical 
procedure where the cervix is opened (dilated) 
and a curette (a thin instrument) is used to scrape 
the uterine lining (endometrium) to further 
evaluate abnormalities. 
 
 
Ethical Statement 
 
● Ethical approval was not applied due to 
no effect in patient-care 
● Informed consent was not necessary due 
to non-identification, keeping privacy in 
case data 
● No financial support for this research 
● The author reports no conflict of interest 
 
 
 
 
 
References 
 
Adekambi, V. (2024). ProQuest | Temporal 
trends in treatment and outcomes in endometrial 
carcinoma in the United States . 
https://www.proquest.com/docview/3037357128
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eDhm7Nj0pwA6W%2ByJwRY0WE%3D&pq-o
rigsite=primo&sourcetype=Scholarly%20Journa
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American Joint Committee on cancer. ACS. 
(n.d.). 
https://www.facs.org/quality-programs/cancer-pr
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Barakat, R., Waggoner, Steven., Fraser, Heidi., 
Keys, Henry. (2006). Treatment Effects, Disease 
Recurrence, and Survival in Obese Women With 
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https://acsjournals-onlinelibrary-wiley-com.prox
y.seattleu.edu/doi/full/10.1002/cncr.22351 
GE Healthcare (2023). Using Ultrasound to to 
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Cleveland Clinic (2023). Endometrial Biopsy. 
https://my.clevelandclinic.org/health/diagnostics/
15676-endometrial-biopsy 
Epstein, E., Fischerova, D., Valentin, L., Testa, 
A.C., Franchi, D., Lindqvist, P.G., Mascillini, F., 
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