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Cited by 41Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

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

Open access
Francica, Giampiero·2012·World Journal of Radiology
DOI 10.4329/wjr.v4.i4.135PMC PMC3351681
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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.

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  • Sonographic studies have described abdominal wall endometriosis as solid lesions with ill-defined blurred outer borders and a hyperechoic ring corresponding to edematous adipose tissue filled with inflammatory cells.

    “Interestingly, the few studies that consider the sonographic features of abdominal wall endometriosis have described specific features, including solid lesions with ill-defined blurred outer borders and the presence of a hyperechoic ring. The latter correspond to adipose tissue that has become edematous and is filled with cells of inflammatory origin (9, 10).”

    From Abdominal wall endometriosis: differentiation from other masses using CT features (2017) · cites this paper as [9]

  • Abdominal wall endometriosis is associated with cesarean delivery and abdominal hysterectomy.

    “One probable exception might be the abdominal wall endometriosis (AWE), which is associated with cesarean delivery and abdominal hysterectomy [102,103].”

    From The Pathogenesis of Adenomyosis vis-à-vis Endometriosis (2020) · cites this paper as [103]

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Research works printed but not linked: 5

  1. Olive DL, Schwartz LB. Endometriosis. N Engl J Med 1993; 328: 1759-1769
  2. Woodward PJ, Sohaey R, Mezzetti TP. Endometriosis: radio- logic-pathologic correlation. Radiographics 2001; 21: 193-216; questionnaire 288-294 294 94
  3. Nirula R, Greaney GC. Incisional endometriosis: an underap- preciated diagnosis in general surgery. J Am Coll Surg 2000; 190: 404-407
  4. Pathan ZA, Dinesh U, Rao R. Scar endometriosis. J Cytol 2010; 27: 106-108
  5. Dwivedi AJ, Agrawal SN, Silva YJ. Abdominal wall endome- triomas. Dig Dis Sci 2002; 47: 456-461

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Authors
Francica, G.
Corresponding author
Francica, Giampiero
ORCID
Francica, Giampiero
Venue
World Journal of Radiology
Publisher
Baishideng Publishing Group Inc.
Published
2012
Volume
4
Issue
4
Pages
135
ISSN
1949-8470 (ISSN-L)
DOI
10.4329/wjr.v4.i4.135
PMC
PMC3351681
OpenAlex
W2013164679
Cited by
41
References
32
Citations by year
2023: 3 · 2022: 4 · 2021: 2 · 2020: 7 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 1 · 2014: 6 · 2013: 6 · 2012: 1
FWCI
4.84
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • World Journal of Radiology (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
abdominal wall endometriosis, cesarean section scar, endometrioma size, sonographic features, color Doppler ultrasound, fistulous tract, delayed diagnosis, ultrasound-guided biopsy, surgical excision, recurrence after excision

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