CoChat
Sign Up
Cited by 14Endometriosis Research and TreatmentGynecological conditions and treatmentsTeratomas and Epidermoid Cysts

Abdominal Wall Endometrioma: Ultrasonographic Features and Correlation with Clinical Findings

Open access
Solak, Aynur, Genc, Berhan, Yalaz, Seyhan, Sahin, Neslin, Sezer, Taylan Ozgur, Solak, Ilhami·2013·Balkan Medical Journal
DOI 10.5152/balkanmedj.2012.102PMC PMC4115979
Open this paper in CoChat — free account

Abstract

BACKGROUND: The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. AIMS: To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. STUDY DESIGN: This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. METHODS: Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fisher's exact test, χ(2) test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. RESULTS: In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). CONCLUSION: AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma.

AI snapshot

Written from the paper’s full text.

TL;DR

In 11 women with 12 caesarean-scar abdominal wall endometriomas, ultrasound consistently showed a solid hypoechoic abdominal-wall mass, and larger lesions were associated with more prior caesareans, longer intervals since last caesarean, and central vascularity. The authors conclude that sonographic and Doppler findings, correlated with clinical history, can help diagnose AWE, though imaging remains nonspecific.

Key findings

  • All 11 women (mean age 32.6 years, range 26–43) had prior caesarean delivery (mean 1.8 sections per patient; min 1, max 4) and 12 scar endometriomas (mean diameter 29.2 mm, range 13–58 mm); ultrasound showed a solid hypoechoic mass within the abdominal wall in all women.
  • Large endometriomas (≥30 mm) versus small lesions were associated with more caesarean sections (2.5 vs. 1.3, p<0.05), longer time since last caesarean delivery (64.0±14.5 vs. 31.2±11.3 months, p<0.05), and longer symptom duration before admission (34.3±11.9 vs. 12.1±9.6 months, p<0.05).
  • Large lesions showed increased central vascularity (4 vs. 0, p<0.05), while peripheral vascularisation did not differ significantly (4 vs. 6, NS); cyclic pain was more frequent in small lesions (0 vs. 5, p<0.05), and continuous pain was more common in larger lesions (4 vs. 0, p<0.05).
  • MRI findings were nonspecific: lesions were isointense to muscle on T1-weighted sequences, high signal on fat-saturated T2-weighted images, and showed marked homogeneous contrast enhancement.

Methods

  • Retrospective review at the Radiology Department of Sifa University Hospital, Izmir: 13 patients with AWE were operated on during a 2-year period; 2 were excluded for poor-quality images, leaving 11 women with 12 scar endometriomas consecutively seen between June 2010 and April 2012.
  • All patients underwent US and Colour Doppler US before surgery using 3.5/5.0-MHz convex-array and 7.5-MHz linear-array transducers; vascularity was classified by location (central, peripheral, mixed) and severity (absent, moderately vascular, hypervascular), and resistance index was measured.
  • MRI was also performed in some patients on a 1.5-T scanner; statistical analysis used Fisher’s exact test, χ² test for categorical data, and unpaired t-test for continuous variables, with p<0.05 considered significant.

Limitations

  • The authors state the study is retrospective, included only patients with AWE, had no predetermined standardised examination protocol, and was based on a limited number of patients that should be confirmed in a larger series.
  • The text itself shows a discrepancy in MRI reporting: the abstract says four patients underwent MRI, while the Methods section says five patients also underwent MRI.
  • Evident from the text: no pre-operative diagnostic biopsy or FNAB was performed on the lesions, and the study was single-centre with a small sample.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.5152/balkanmedj.2012.102

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The echotexture of abdominal wall endometrioma was inhomogeneous in 6 of 12 (50%) cases.

    “The echotexture was inhomogeneous in 6 of 12 (50%) cases owing to the presence of inner hyperechoic fibrotic spots, short white cords or small cystic foci (Figure 1a).”
    Quote in the paperNot a substantial claim
  • Findingown data

    There were mixed-branching hypervascular flow patterns in four patients with lesion size >3 cm.

    “There were mixed-branching hypervascular flow patterns in four patients with a lesion size of more than 3 cm (Figure 1b, c).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The average time of symptoms before admission was 22.7 months (range 3-45 months).

    “the average time of symptoms before admission was 22.7 months (range 3-45 months).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Large endometriomas showed increased central vascularity (p<0.05).

    “Large endometriomas showed increased central vascularity (p<0.05).”
    • Also stated in: § Discussion · plain
      “We found prominent central vascularity in four large nodules, while only two nodules were avascular.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In our study, conventional MR sequences revealed non-specific imaging findings identical to that of soft tissue malignancy.

    “In our study, conventional MR sequences revealed non-specific imaging findings identical to that of soft tissue malignancy.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 10
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    MRI revealed abdominal wall endometrioma lesions to be isointense compared to muscle on T1-weighted sequence, high signal intensity on fat-saturated T2-weighted images, and with marked-homogeneously contrast enhancement.

    “MRI revealed the lesions to be isointense compared to muscle on the T1-weighted sequence, as high signal intensity on fat-saturated T2-weighted images, and with marked-homogeneously contrast enhancement (Figure 1d).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    In larger lesions, CDUS revealed multiple vascular pedicles entering the mass from different points and abundant central vascularisation, in contrast with absent central vessels seen in smaller incisional endometriomas.

    “In larger lesions, CDUS revealed multiple vascular pedicles entering the mass from different points and an abundant central vascularisation in contrast with absent central vessels seen in smaller incisional endometriomas.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05).

    “Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05).”
    • Also stated in: § L-AWE S-AWE p · plain
      “Cyclic pain was more frequent in small endometriomas, whereas continuous pain or painless lumps were more often seen in patients with larger lesions (p<0.05)(Table 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Findingown data

    The presumptive clinical diagnosis before radiologic consultation was not abdominal wall endometrioma in most patients (7 of 11).

    “The presumptive clinical diagnosis before radiologic consultation was abdominal wall endometriosis (n=4), suture granuloma (n=3), appendicitis (n=2), or haematoma (n=2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In our study, sonographic examination revealed these masses to be solid, hypoechoic lesions in the abdominal wall and to contain internal vascularity on CDUS.

    “In our study, sonographic examination revealed these masses to be solid, hypoechoic lesions in the abdominal wall and to contain internal vascularity on CDUS.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the remaining 8 nodules, all <3 cm, peripheral vascularity was observed in 5 nodules and no vascularity in 3 nodules.

    “larity was observed in 5 nodules (moderately vascular n=4, highly vascular n=1) and no vascularity was seen in 3 nodules (Figure 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    We found prominent central vascularity in four large nodules, while only two nodules were avascular.

    “We found prominent central vascularity in four large nodules, while only two nodules were avascular.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Four patients (36.3%) had large endometriomas (≥30 mm) with a mean lesion diameter of 41.3±9.02 mm (range 30-60 mm).

    “four patients (36.3%) had large endometriomas (≥30 mm) with a mean lesion diameter of 41.3±9.02mm (range 30-60 mm).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Seven women (63.7%) had small endometriomas with a mean lesion size of 19.2±5.18 mm (range 9-27 mm).

    “Seven women (63.7%) had small endometriomas with a mean lesion size of 19.2±5.18mm (range 9-27 mm).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients with lesion sizes larger than 3 cm had a longer mean time interval between last operation and admission and longer duration of symptoms before admission compared to patients with smaller lesions (34.3 vs 12.1 months, p<0.05).

    “Patients with lesion sizes larger than 3 cm had a longer mean time interval and the longer duration of symptoms before hospital admission when compared to the patients with smaller lesions (34.3 months vs. 12.1 months, p<0.05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The distribution of abdominal wall endometrioma lesions by depth was: 4 between subcutaneous rectus muscle sheath, 3 invading both subcutaneous and muscular plane, 3 purely subcutaneous, and 2 entrapped in muscular layer.

    “Four nodules (33.3%) were located between the subcutaneous rectus muscle sheath; in three cases (25%) both the subcutaneous and muscular plane were invaded; three lesions (25%) were purely subcutaneous and two more nodules (16.7%) were entrapped in the muscular layer of the abdominal wall.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nine patients had a single nodule, one had two nodules, one had multiple adjacent millimetric cysts.

    “Nine patients had a single nodule, one patient had two nodules (one large nodule associated with a small lesion) and one patient had multiple adjacent millimetric cysts (large nodule was found surrounded by small chocolate cysts) (Figure 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The signal characteristics and contrast enhancement pattern of abdominal wall endometrioma 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.

    “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).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13]

      Not checked in the free run.

    • cites [18]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    FNAB has been reported to diagnose endometrioma in isolated cases.

    “FNAB has been reported to diagnose endometrioma in isolated cases (6,11,21,22).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [6]

      Not checked in the free run.

    • cites [11]

      Not checked in the free run.

    • cites [21]

      Not checked in the free run.

    • cites [22]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Because of the lack of specific imaging features, there is no need to use other expensive diagnostic modalities, such as MRI and CT.

    “Because of the lack of specific imaging features, there is no need to use of other expensive diagnostic modalities, such as MRI and CT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Small lesions are located in hypovascular subcutaneous fat, thus their growth is limited.

    “However, small lesions are located in hypovascular subcutaneous fat, thus their growth is limited (13)(14)(15).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (13)(14)(15)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study is based on a limited number of patients and should be confirmed in a larger series.

    “Finally, our study is based on a limited number of patients and should be confirmed in a larger series of patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Abdominal wall endometrioma is difficult to diagnose radiologically and usually mimics a malignant soft tissue tumour.

    “It is also difficult to diagnose radiologically, and usually mimics a malignant soft tissue tumour (1)(2)(3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (1)(2)(3)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All lesions were examined using a high-frequency linear transducer and CDUS examination was performed in all masses.

    “Against all odds, all lesions were examined using a high-frequency linear transducer and CDUS examination was performed in all masses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A consensus was achieved by the authors for every lesion, by reviewing several digital documentations.

    “Furthermore, a consensus was achieved by the authors for every lesion, by reviewing several digital documentations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    If the lesion is not completely removed, it can reoccur or new lesions can form if the neighbouring parenchyma is inoculated during the operation.

    “If the lesion is not completely removed, it can reoccur or new lesions can form if the neighbouring parenchyma is inoculated during the operation (21)(22)(23)(24).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (21)(22)(23)(24)

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Larger lesions extend deeper and feed from the rich vasculature of the rectus sheath (via deep branches of inferior and superior epigastric arteries).

    “Larger lesions extend deeper and feed from the rich vasculature of the rectus sheath (via deep branches of inferior and superior epigastric arteries).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (13)(14)(15)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Continuous pain or painless lumps may occur, but has generally been regarded as atypical.

    “Continuous pain or painless lumps may occur, but has generally been regarded as atypical (11), which may explain why it is clinically often recognised late, as was the case in our patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only 26% of patients presenting with extrapelvic endometrioma also have intrapelvic endometriosis.

    “Only 26% of patients presenting with extrapelvic endometrioma also have intrapelvic endometriosis (6).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In general, the characteristic clinical symptom of endometriosis is cyclic pain associated with menstrual periods.

    “In general, the characteristic clinical symptom of endometriosis is cyclic pain associated with menstrual periods (8,9).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8]

      Not checked in the free run.

    • cites [9]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Extrapelvic endometriosis most commonly occurs in the abdominal wall.

    “Extrapelvic endometriosis affects nearly every organ, except the heart and the spleen, but its most common location is in the abdominal wall (7)(8)(9).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (7)(8)(9)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The echo pattern may or may not correlate with the menstrual period, and sonographic findings are nonspecific.

    “The echo pattern may or may not correlate with the menstrual period, and sonographic findings are nonspecific (13).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13]

      Not checked in the free run.

27 of 27

  • The paper relies on this without support.

    There is not always a palpable tender mass in abdominal wall endometrioma.

    “there is not always a palpable tender mass.”
    “there is not always a palpable tender lump.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Various imaging modalities such as ultrasonography, computed tomography, and MRI are nonspecific but can help determine the extent of the disease and assist in planning for surgical resection.

    “Various imaging modalities such as ultrasonography, computed tomography, and MRI are nonspecific but can help determine the extent of the disease and assist in planning for surgical resection [13].”

    From Resection and Abdominal Wall Reconstruction for Cesarean Scar Endometriosis (2022) · cites this paper as [13]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Avascular nodule count differs

    Major

    The Results section reports three nodules with no vascularity, while the Discussion says only two were avascular.

  • Reported overall symptom duration does not match subgroup means

    Minor

    For the stated groups of four and seven patients, the subgroup means of 34.3 and 12.1 months give an overall mean of about 20.2 months, not 22.7 months.

    Reported 22.7 · recomputed 20.172727

  • Figure describes cyclic pain in a large lesion despite table count of zero

    Minor

    Figure 1 describes cyclic pain in a patient with a 33 mm lesion, which meets the paper's ≥30 mm definition of a large nodule. Table 1 reports zero large-lesion patients with cyclic pain.

  • Overall lesion-size range excludes subgroup extremes

    Minor

    The overall range is 13-58 mm, but the reported large-lesion range reaches 60 mm and the small-lesion range starts at 9 mm.

  • MRI patient count differs

    Minor

    The abstract says four patients underwent MRI, whereas the Methods section says five did.

  • Small-nodule peripheral vascularity count differs

    Minor

    The Results text reports peripheral vascularity in five of the eight small nodules, but Table 1 lists six for the small-lesion group.

6 of 6

Cites

Flagged first, then by citations

3 of the 29 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Solak, A., Genc, B., Yalaz, S., Sahin, N., Sezer, T. O., & Solak, I.
Affiliations
Şifa University (TR)
ORCID
Solak, Aynur
Venue
Balkan Medical Journal
Publisher
AVES Publishing Co.
Published
2013-07-01
Volume
30
Issue
2
Pages
155-160
ISSN
  • 1301-3149 (ISSN-L)
  • 2146-3123
  • 2146-3131
DOI
10.5152/balkanmedj.2012.102
PMC
PMC4115979
OpenAlex
W2025922202
Semantic Scholar
94f0c6a3a9c427a73d7f3105a6f8e36a57def09d
Cited by
14
References
29
Citations by year
2022: 1 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 2
FWCI
0.00
Type
journal article
Language
en
Open access
Locations
  • Balkan Medical Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DergiPark (Istanbul University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Surgery › Teratomas and Epidermoid Cysts
Keywords
endometriosis, sonographic features, colour Doppler sonography, lesion size, vascularity, cyclic pain, cesarean section, misdiagnosis, magnetic resonance imaging

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review