Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. Apr 28, 2012; 4(4): 135-140
Published online Apr 28, 2012. doi: 10.4329/wjr.v4.i4.135
Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar
Giampiero Francica
Giampiero Francica, Unit of Diagnostic and Interventional ultrasound, Camilliani Hospital, “S. Maria della Pieta”, S. Rocco St. 9, 80026 Casoria, Italy
Author contributions: Francica G designed the study, performed the research, analyzed the data, and drafted the manuscript.
Correspondence to: Dr. Giampiero Francica, Unit of Diagnostic and Interventional Ultrasound, Presidio Ospedaliero Camilliani, “S. Maria della Pieta”, via S. Rocco 9, 80026 Casoria, Italy. giampierofrancica@gmail.com
Telephone: +39-81-5408262 Fax: +39-81-7586638
Received: October 28, 2011
Revised: March 23, 2012
Accepted: March 30, 2012
Published online: April 28, 2012
Abstract

AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features.

METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases.

RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04).

CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.

Keywords: Cesarean section scar; Endometrioma; Ultrasound