Case notes
A 28-year-old woman had a 6-year history of secondary infertility. Her first pregnancy was a normal delivery at term 8 years earlier. This was followed by a second-trimester loss at 14 weeks of gestation that required surgical evacuation. The patient had regular menstrual cycles after the procedure.
Hysterosalpingography showed a normal uterine cavity with bilateral free spill of contrast agent into the peritoneal cavity. The patient’s hormonal profile and her husband’s semen analysis were within normal limits. On transvaginal ultrasonography, a linear echogenic density that was suggestive of calcified lesions was observed ( Figure 1 ).
In addition, a grating sensation was noted in the endometrial cavity when the uterus was sounded. Diagnostic hysteroscopy indicated a pale endometrium with white, bone-like, spicules deeply embedded in the mucosa of a lateral wall. The cervix was dilated, and the bony spicules were removed from the uterine cavity by curettage with ultrasound guidance ( Figure 2 ). Repeat hysteroscopy showed no spicules. Histopathologic examination indicated fragments of lamellar bone with osseous metaplasia of the endometrium.
