Case Review: Ultrasound of Endometrioma

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In this radiology lecture, we review the ultrasound appearance of endometrioma through three unique cases, including an MRI example.

Key teaching points include:

  • Endometriosis = Ectopic endometrial glands and stroma outside of the uterine cavity. Includes endometriomas, extraovarian implants and adhesions.
  • Endometriomas = Endometriotic cysts within ovary.
  • Endometriosis is seen in about 10% of women of reproductive age.
  • Presentation: Pelvic pain, dysmenorrhea, dyspareunia, infertility.
  • Ultrasound: Diffuse, homogeneous low-level echoes (most specific feature) yielding a ground glass appearance. May have posterior acoustic enhancement.
  • Endometriomas may have peripheral punctate echogenic foci. These foci have no internal vascular flow but can see twinkle artifact.
  • Vascular flow may be present in endometrioma septations.
  • Endometrioma vs. hemorrhagic cyst: Hemorrhagic cysts are acute, usually solitary and unilocular, whereas endometriomas are chronic, sometimes multiple and multilocular.
  • Endometriomas can rarely (1%) undergo malignant transformation into endometrioid carcinoma or clear cell carcinoma.
  • MR is the most specific imaging modality for diagnosis of endometrioma = Specificity 98%.*
  • Homogeneous, T1 “light bulb” bright, T2 dark = “T2 shading.”
  • Surgical treatment: Depends on disease severity from laparoscopic cyst aspiration/cystectomy to hysterectomy/oophorectomy.
  • Medical management may be attempted: Oral contraceptives, GnRH agonists

*Reference: Togashi K, Nishimura K, Kimura I, et al. Endometrial cysts: Diagnosis with MR imaging. Radiology. 1991;180:73-78.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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