Endometriosis Ultrasound

Endometriosis Ultrasound Findings – Comprehensive Guide

What is Endometriosis?

Endometriosis is a chronic disease characterized by the presence of tissue similar to the lining of the uterus outside the uterus. It is associated with pelvic pain, menstrual cramps, and infertility.

The Role of Ultrasound

Transvaginal ultrasound (TVUS) is the first-line imaging method for evaluating endometriosis. In experienced hands, it provides high diagnostic accuracy.

Endometrioma (Chocolate Cyst) Findings

The most typical ultrasound finding is a homogeneous 'ground glass' appearance with low-level internal echoes. It can often be bilateral and has thick walls.

Deep Infiltrating Endometriosis (DIE)

Rectovaginal septum, uterosacral ligaments, and bowel involvement are observed as hypoechoic, irregularly bordered nodules.

Sliding Sign Assessment

Restricted movement between the uterus and the rectum or ovaries suggests the presence of adhesions. A negative sliding sign is an indicator of advanced disease.

Adenomyosis Ultrasound Findings

Heterogeneous myometrium, myometrial cysts, asymmetric wall thickness, and junctional zone irregularities may be observed.

Bowel Involvement

It is observed as thickening of the bowel wall and hypoechoic nodules. Rectosigmoid involvement is particularly common.

Ovary and Tube Findings

Fixation of the ovaries, 'kissing ovaries' appearance, and hydrosalpinx may be present.

Doppler Findings

Generally, low vascularity is observed. However, Doppler evaluation is important for the differential diagnosis of malignancy.

Limitations of Ultrasound

Small lesions and superficial implants may not always be visible. Therefore, it should be evaluated in conjunction with clinical findings and other imaging methods.

Conclusion

An experienced ultrasound evaluation is critically important for the diagnosis of endometriosis and surgical planning.