Abstract
In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in “atypical” sites, in all the cases where “typical” clinical findings are present.
Highlights
Most commonly, endometriosis affects the ovaries, pelvic peritoneum, uterosacral ligaments, fallopian tubes, and broad ligaments [1]
The reported incidence of scar endometriosis is about 3.5% in Cesarean sections represent the strongest risk factor for scar endometriosis considering the close patients who undergo gynecological surgery and about 0.8% in all women with a previous C‐section contact that may commonly occur between endometrial cells and the subcutaneous during this type
C-section scar, endometriosis should be included in the differential abdominal solid mass spotted at ultrasound cannot be immediately considered as endometriosis, if diagnosis
Summary
Endometriosis affects the ovaries, pelvic peritoneum, uterosacral ligaments, fallopian tubes, and broad ligaments [1]. Extragenital implants of endometriosis can be spotted virtually in any other pelvic compartment [2]; extra-pelvic foci of ectopic endometrial tissue have been described in almost every organ and tissue of the body [3]. Clinicians should be aware of the fact that any symptom affecting extra-pelvic sites and described by a patient of child-bearing age as “cyclical” might be a possible indicator of endometriosis and deserves further investigation. While the rectosigmoid colon is the most common location (52–72%) but has to be included in pelvic endometriosis, endometriotic implants can be found in the small bowel, especially in the terminal ileum (4.1–16.9%). As a matter of fact, the most common location of extra-pelvic intestinal endometriosis is the last part of the ileum (the small intestine), the cecum (the first part of the large bowel), and the appendix [6]
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