Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar

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 �oppler 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��

Abdominal Wall Endometrioma: Ultrasonographic Features and Correlation with Clinical Findings

“…The sonographic appearance of abdominal wall endometrioma can be cystic, multicystic, mixed, or solid (12). The echo pattern may or may not correlate with the menstrual period, and sonographic findings are nonspecific (13). In our study, sonographic examination revealed these masses to be solid, hypoechoic lesions in the abdominal wall and to contain internal vascularity on CDUS.…”

“…AWE cannot be distinguished from invasive abdominal masses by CT (12,14,17). Although, typically, MRI is suited best for defining the anatomy of the soft tissue mass and its surrounding structures, the signal characteristics and contrast enhancement pattern of AWE are not specific, and the true histological nature of the tumour or other soft-tissue masses often cannot be ascertained by imaging alone, with few exceptions (e.g., lipoma or haemorrhage) (13,18). However, MRI has become a useful tool in AWE to provide a roadmap for operations to determine the location and depth of infiltration in the surrounding tissues.…”

“…Larger lesions extend deeper and feed from the rich vasculature of the rectus sheath (via deep branches of inferior and superior epigastric arteries). However, small lesions are located in hypovascular subcutaneous fat, thus their growth is limited (13)(14)(15). In the presence of a rapidly growing, painless mass and the absence of previous surgery, malignant soft tissue masses in the abdominal wall should be considered in the imaging differential diagnosis.…”

“…In fact, small, superficially-located nodules are relatively easy to remove. Those lesions which have invaded the rectus sheath or are located deeper in the muscle layer will require a wider laparotomy for complete resection, and the risks and healing time will be greater (13,21,25).…”

Endometriosis in postoperative scar

“…Эндометриоз достаточно частое заболе-вание у женщин репродуктивного возраста, однако его локализация в области послеопе-рационного рубца (Эпр) относится к редким формам и в литературе имеются публикации по данной патологии в виде описания отдель-ных клинических наблюдений или небольших серий [1][2][3][4][5][6][7][8][9][10][11][12][13]. в большинстве случаев Эпр возникает после кесарева сечения и других гинекологических операций (гистерэктомии, удаления эндометриоидных кист яичника) [7,[11][12][13] и, тем не менее, в литературе опублико-ваны документированные наблюдения данно-го вида экстрагенитального эндометриоза по-сле хирургических операций (аппендэктомия, холецистэктомия, грыжесечение) [4,8,11].…”