Direct Spread Research Articles

The Evidence for a Causal Link Between Disease and Damaging Behavior in Pigs.

Damaging behaviors (DB) such as tail and ear biting are prevalent in pig production and reduce welfare and performance. Anecdotal reports suggest that health challenges increase the risk of tail-biting. The prevalence of tail damage and health problems show high correlations across batches within and between farms. There are many common risk factors for tail-biting and health problems, notably respiratory, enteric and locomotory diseases. These include suboptimal thermal climate, hygiene, stocking density and feed quality. The prevalence of tail damage and health problems also show high correlations across batches within and between farms. However, limited evidence supports two likely causal mechanisms for a direct link between DB and health problems. The first is that generalized poor health (e.g., enzootic pneumonia) on farm poses an increased risk of pigs performing DB. Recent studies indicate a possible causal link between an experimental inflammation and an increase in DB, and suggest a link between cytokines and tail-biting. The negative effects of poor health on the ingestion and processing of nutrients means that immune-stimulated pigs may develop specific nutrient deficiencies, increasing DB. The second causal mechanism involves tail-biting causing poor health. Indirectly, pathogens enter the body via the tail lesion and once infected, systemic spread of infection may occur. This occurs mainly via the venous route targeting the lungs, and to a lesser extent via cerebrospinal fluid and the lymphatic system. In carcasses with tail lesions, there is an increase in lung lesions, abscessation, arthritis and osteomyelitis. There is also evidence for the direct spread of pathogens between biters and victims. In summary, the literature supports the association between poor health and DB, particularly tail-biting. However, there is insufficient evidence to confirm causality in either direction. Nevertheless, the limited evidence is compelling enough to suggest that improvements to management and housing to enhance pig health will reduce DB. In the same way, improvements to housing and management designed to address DB, are likely to result in benefits to pig health. While most of the available literature relates to tail-biting, we suggest that similar mechanisms are responsible for links between health and other DB.

Directional characteristics of spatially evolving young waves under steady wind

A novel nonintrusive optical wave gauge is developed to simultaneously measure three components of the wave field. The synchronous single point measurement of temporal variation of surface elevation and its orthogonal slope components allowed us to estimate directional spectra. Unlike in field experiments, where the directional wave spreading is affected also by variation in the wind direction, in a laboratory facility the wind is unidirectional thus allowing characterization of directional spreading as an intrinsic property of wind waves.

A spectral description for extreme sea states offshore Denmark Part I: Power spectrum

A power spectral density function that describes extreme sea states in the Danish sector of the North Sea is developed. The power spectrum is specified in terms of the parameters: significant wave height, spectral peak period, and spectral second-moment period. The power spectral density function is a modified Torsethaugen spectrum, involving an expression for the peak enhancement factor that is dependent on the inverse of the square root of wave steepness and a high-frequency tail that decays at a rate which is dependent on the significant wave height and the ratio of the peak and second-moment periods. The new function was developed from Directional Waverider data measured at two sites in the Danish sector of the North Sea and validated with data from other sites offshore Denmark, primarily recorded with Saab WaveRadars. A companion paper describes a new directional spreading function, which together with the power spectral density function, provides a description of the complete frequency-direction spectrum of extreme sea states in the Danish sector of the North Sea.

Genital Tuberculosis and Infertility: A Comparative Analysis of Imaging Modalities

Background: Female genital tuberculosis is caused by Mycobacterium tuberculosis and occurs usually secondary to pulmonary tuberculosis or other organs with infection reaching through hematogenous route, lymphatic route or direct spread from abdominal tuberculosis. Diagnosis of genital tuberculosis is often made from history taking, meticulous clinical examination and use of investigations such as endometrial aspirate/biopsy and endoscopy. Female genital tuberculosis damages the genital organs causing menstrual dysfunction and infertility. The aim of the study was to evaluate co relation of genital tuberculosis with infertility and role of imaging modalities in diagnosing genital TB. During December 2020 we searched Google scholar, pub med, Medscape research articles from 2010 -2020. Genital TB is one most common cause of infertility in developing countries while diagnostic ultrasonography plays a limited role to diagnose. Laprohysteroscopy and histo-pathological analysis are confirmatory for genital tuberculosis. Keywords: Genital tuberculosis, Infertility, Pyosalpinx, Tubo-ovarian mass, Ultrasonography and Hysterosalpingography.

Numerical Investigation of Single-Row Double-Jet Film Cooling of a Turbine Guide Vane under High-Temperature and High-Pressure Conditions

Single-row double-jet film cooling (DJFC) of a turbine guide vane is numerically investigated in the present study, under a realistic aero-thermal condition. The double-jet units are positioned at specific locations, with 57% axial chord length (Cx) on the suction side or 28% Cx on the pressure side with respect to the leading edge of the guide vane. Three spanwise spacings (Z) in double-jet unit (Z = 0, 0.5d, and 1.0d, here d is the film hole diameter) and four spanwise injection angles (β = 11°, 17°, 23°, and 29°) are considered in the layout design of double jets. The results show that the layout of double jets affects the coupling of adjacent jets and thus subsequently changes the jet-in-crossflow dynamics. Relative to the spanwise injection angle, the spanwise spacing in a double-jet unit is a more important geometric parameter that affects the jet-in-crossflow dynamics in the downstream flowfield. With the increase in the spanwise injection angle and spanwise spacing in the double-jet unit, the film cooling effectiveness is generally improved. On the suction surface, DJFC does not show any benefit on film cooling improvement under smaller blowing ratios. Only under larger blowing ratios does its positive potential for film cooling enhancement start to show. Compared to the suction surface, the positive potential of the DJFC on enhancing film cooling effectiveness behaves more obviously on the pressure surface. In particular, under large blowing ratios, the DJFC plays dual roles in suppressing jet detachment and broadening the coolant jet spread in a spanwise direction. With regard to the DJFC on the suction surface, its main role in film cooling enhancement relies on the improvement of the spanwise film layer coverage on the film-cooled surface.

Iliopsoas abscess in infants: A case report

Introduction. Iliopsoas abscess is a rare condition, which may be categorized as primary or secondary. Primary iliopsoas abscess is caused by lymphohematogenous spread of infectious agents from a distant site, unlike secondary iliopsoas abscess that is a result of direct spread of a nearby infectious or inflammatory process. The diagnosis and treatment of primary iliopsoas abscess are often prolonged, due to the rarity of the disease and the nonspecific signs and symptoms. Case Report. This study presents a case of a onemonth old infant with a left-sided iliopsoas abscess. The physical examination revealed a swelling with a pronounced vascular pattern in the area of the left groin. Laboratory findings showed leukocytosis and increased inflammatory markers. An abscess within the left hemiabdomen and inguinofemoral region was diagnosed by ultrasonography and computerized tomography. The main therapeutic approach included antibiotic therapy, as well as surgical drainage of the abscess. Staphylococcus aureus was isolated from a 100 ml sample of the drained abscess. The treatment outcome was good. Conclusion. Given the frequency of iliopsoas abscess in infants, which is far less common than other primary diseases, greater attention must be paid to symptoms and signs during clinical examination, along with the appropriate choice of diagnostic procedures. Timely diagnosis, as well as adequate treatment of iliopsoas muscle abscess, is imperative in order to prevent the development of complications, such as systemic inflammation and sepsis.

Effects of Ocean Wave Directional Spectra on Doppler Retrievals of Ocean Surface Current

The Doppler shift of microwave radar signal is determined by the relative motion between radar and ocean surface, including contributions from the movement of the radar platform and the wind-wave-induced motion (phase velocity of the resonant Bragg waves and orbital motions of ocean waves that are longer than the Bragg waves) in addition to the ocean surface current. One of the main challenges in ocean surface current retrieval is the accurate estimation of the wind-wave-induced Doppler shift, which needs to be accurately removed from the total Doppler shift to determine the surface current. In this study, we investigate the effects of different wave directional spectra on estimates of the wind-wave-induced Doppler shift using a modulation transfer function (MTF)-based and time-independent Doppler model. Our results show that the wind-wave-induced Doppler shift estimates are highly dependent on the selection of wave spectra and the directional spreading function. This study also confirms the importance of ocean wave spectra parameterization on Doppler estimation of the ocean current. We find that Apel’s spectra model is a more consistent fit to the observations, but the optimal spreading function is wind-speed-dependent.

Antibiotic resistance pattern of methicillin-resistant Staphylococcus aureus and Escherichia coli from mobile phones of healthcare workers in public hospitals in Ghana.

Introductionmobile phone plays an essential role in the lives of healthcare professionals in hospitals as far as communication is concerned. However, it can also serve as a source of nosocomial infections. This study aimed at determining the prevalence and antibiotic susceptibility of Methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli isolated from mobile phones used by healthcare staff working in three public hospitals in Ghana.Methodsin total, 220 swab samples were collected from 110 mobile phones of healthcare workers at a referral and two public tertiary hospitals in Ghana. Direct spreading of swab samples on agar plates was done. MacConkey agar and Baird Parker agar were used to isolate E. coli and S. aureus, respectively. Clinical Laboratory Standard Institute´s guidelines were followed for susceptibility testing, and S. aureus strains resistant to cefoxitin were considered to be MRSA. All E. coli and MRSA isolates were tested for their susceptibility to antibiotics using European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2018 guidelines with its breakpoints. Obtained qualitative data were analyzed by using Microsoft Excel.Resultsof 110 mobile phones, 78 (70.9%) and 4 (3.6%) were colonized with S. aureus and E. coli, respectively. From the 78 S. aureus isolates, 22 (28%) isolates were MRSA. Fifty percent (50%) (11/22) of the MRSA isolates were multi-drug resistant, of which one isolate was resistant to all antibiotics tested. E. coli isolates had 100 resistances to both ceftriaxone and ceftazidime.Conclusionmobile phones used by healthcare workers in hospitals frequently harbor E. coli, S. aureus, MRSA and may be sources of hospital-associated infections.

Wind Direction Inversion Using Shore-Based UHF Radar

Shore-based Ultra-high-frequency (UHF) radars have similar characteristics as the High-frequency (HF) ocean radars, for example, the sea waves generating Bragg resonance are gravity waves. Compared to HF radars, UHF radars are more sensitive to the small changes of sea waves, have finer spatial resolution and measure sea areas closer to the coast, hence are expected to complement the nearshore sensing capacity of HF radars. Two wind direction inversion methods for coastal UHF radars are adopted. One is based on the Bragg peak power ratio and the other is based on the modified Doppler spectrum centroid. The latter is proposed to address the problem that it is often difficult to calculate the Bragg peak power ratio at high wind speeds. In both methods, several models describing the relationship between the Doppler spectrum characteristics and wind direction are used respectively in combination with the least square method to estimate the wind direction with the ambiguity removed. Using the buoy wind sensor data as the ground truth, the results of a three-week experiment demonstrate the feasibility of the two methods. It is also shown that the former method has slightly smaller errors and the latter method applies to a wider range of wind speeds. For both methods, the most recommended model is the one based on the cosine-type directional spreading function with variable spreading parameter, because it has small errors and does not require data fitting.

Decoupling of economic growth from CO2 emissions in Yangtze River Economic Belt sectors: A sectoral correlation effects perspective

For making clear decoupling state of sector economic growth from CO2 emissions in the input–output process, in this paper, we firstly explore the correlation effects of sector CO2 emissions by defining it as comprehensive effects of sector CO2 emissions from fossil energy consumption in the initial input, intermediate products, final products and circular correlation of the input–output process, and decomposing it into direct effect, full effect, Spreading effect and sensitive effect. Then we set up a methodology of correlation effects decoupling index to discover their decoupling status and sources. Finally, we concretely investigate the breakthrough points of sector CO2 emissions reduction in the case study of the Yangtze River Economic Belt (the YREB) sectors of China. The results show: (1) Correlation effects of CO2 emissions is higher in the YREB energy-intensive sectors. (2) The YREB sectors of decoupling of economic growth from CO2 emissions decreases obviously from 89.7% to 62.1% from 2007–2012 to 2013–2017, which is impacted by decoupling deterioration of correlation effects of CO2 emissions in the energy-intensive sectors. (3) The YREB key sectors of CO2 emissions reduction are the energy-intensive sectors with focus on the parts of decoupling deterioration of correlation effects of sector CO2 emissions. The proposed analysis framework is efficient for analyzing decoupling of correlation effects of CO2 emissions in the YREB sectors of China, and can also be applied to similar analysis and extended to multi-regional analysis.

Improving Voice Outcomes After Thyroid Surgery - Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve.

Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery

Wettability and Droplet Directional Spread Investigation of Crescent Array Surface Inspired by Slippery Zone of Nepenthes

AbstractIn this report, the surface topography of crescent array in the Nepenthes slippery zone is measured and bionic fabricated by two‐photon polymerization (TPP) technology. A subregion outside‐in scanning method (SOSM) is proposed to solve the photoresist converge and large area surface positioning problem existing in bionic crescent array surface (BCAS) fabrication. The geometric parameters of BCAS, including area fraction, height, offset, and outer–inner radius ratio, are systematically investigated to reveal their effects on the hydrophobic performance. Perfluorinated polyether oil and fluorocarbon solvent were used to increase the hydrophobicity and homogeneity of bionic surface. The contact angles of BCASs coated with and without the solution are measured. The maximum contact angle can reach to 152.1°. What's more, considering the anisotropy of BCAS, anisotropic wetting research is conducted. Offset and outer–inner radius ratio are found to have obvious effects on the contact angle differences between convexity and concavity directions. The maximum contact angle difference can reach to 5.1°. Spreading and pinning phenomenon caused by droplet anisotropic wetting are observed and explained. This work is expected to provide references for the BCAS to be applied in super‐hydrophobic and droplets motion fields.

Transmission and Colonization of Pneumocystis jirovecii.

Pneumocystis spp. was discovered in 1909 and was classified as a fungus in 1988. The species that infects humans is called P. jirovecii and important characteristics of its genome have recently been discovered. Important advances have been made to understand P. jirovecii, including aspects of its biology, evolution, lifecycle, and pathogenesis; it is now considered that the main route of transmission is airborne and that the infectious form is the asci (cyst), but it is unclear whether there is transmission by direct contact or droplet spread. On the other hand, P. jirovecii has been detected in respiratory secretions of hosts without causing disease, which has been termed asymptomatic carrier status or colonization (frequency in immunocompetent patients: 0–65%, pregnancy: 15.5%, children: 0–100%, HIV-positive patients: 20–69%, cystic fibrosis: 1–22%, and COPD: 16–55%). This article briefly describes the history of its discovery and the nomenclature of Pneumocystis spp., recently uncovered characteristics of its genome, and what research has been done on the transmission and colonization of P. jirovecii. Based on the literature, the authors of this review propose a hypothetical natural history of P. jirovecii infection in humans.

Experimental study of wave height, crest, and trough distributions of directional irregular waves on a slope

Presently, most studies of wave height distribution on slopes are based on normal incident unidirectional waves. In this study, the wave height, crest, and trough distributions of oblique incident unidirectional and multidirectional irregular waves on a 1:15 slope were experimentally investigated. The Composite Weibull Distribution fitted the experimental data well and could be applied to predict the wave height, crest, and trough distributions for unidirectional and multidirectional waves on the slope. The shape parameter with a constant value k2 = 3.6 in Composite Weibull Distribution proposed by Battjes and Groenendijk (2000) did not describe the actual variation of wave height distribution in the surf zone. The parameters' values in Composite Weibull Distribution were modified and the corresponding fitted formulas were proposed in this paper. The results showed that the fitting parameters' values of Composite Weibull Distribution between normal and oblique incident irregular waves, and between unidirectional and multidirectional irregular waves were slightly different. But the directional spreading had little effect on the fitting parameters’ values for narrow directional spreading waves. These findings for a 1:15 slope can be referenced as a supplement to the conclusions of Battjes and Groenendijk (2000).

Positive and Negative Ions Potently Inhibit the Viability of Airborne Gram-Positive and Gram-Negative Bacteria.

ABSTRACTPositive and negative ions (PAIs and NAIs, respectively) generated by air ionizers curb indoor spread of airborne pathogens through cellular oxidative damage. Thus, here, we asked whether ion exposure of Staphylococcus aureus and Escherichia coli bacteria—either plated on agar or trapped in air filters—would affect their viability and whether this effect would be influenced by variations in bacterial type and load, action area, distance from the ion generator, exposure time, or filter type. We selected these two vegetative bacterium species because, besides being representative of Gram-positive and Gram-negative strains, respectively, they are widely recognized as the two most common airborne pathogens. We observed a robust ion inhibitory effect on the viability of free bacteria regardless of the experimental condition employed. Specifically, 12-h ion exposure of plated S. aureus and E. coli, at either 5 cm or 10 cm from the ion source, reduced bacterial viability by ∼95% and 70%, respectively. Furthermore, 3-h ion exposure was sufficient to reduce the viability of both bacterial species trapped in filters. Our results showing a strong antibacterial activity of PAI and NAI under all experimental conditions tested further support the use of air ionizers for preventing and/or containing airborne infection in domestic and nondomestic settings.IMPORTANCE Indoor air is a well-established vehicle for direct and indirect spread of a wide variety of human pathogens—as bioaerosols are composed of bacteria, viruses, fungi, and other types of organisms—that may trigger some pathologies. Plasmacluster ionizers are known for their ability to generate positively or negatively charged air ions (PAIs and NAIs, respectively) that can kill/inactivate indoor airborne pathogens, through oxidative stress-induced damage, in various environments. Given these premises, the aim of this study was to evaluate the viability of Gram-positive and Gram-negative bacteria exposed to PAI and NAI under different experimental variables such as bacterial type and load, action area, distance from the ion generator, ion exposure time, and filter type. Altogether, our findings, demonstrating a remarkable PAI and NAI antibacterial activity, stress the importance of using air ionizers to prevent indoor airborne infection.

Estimating ocean wave directional spreading using wave following buoys: a comparison of experimental buoy and gauge data

Directional spreading of ocean waves plays an important role in various aspects of ocean engineering, such as wave-induced loads, nonlinear wave evolution, and wave breaking. Wave following buoys, which are widely deployed across the oceans, offer the potential to measure directional wave properties. To assess the accuracy of directional spreading estimates made using buoy measurements, we compared estimates based on experimentally obtained buoy and wave gauge measurements, first presented in McAllister and van den Bremer (J Phys Oceanogr 50:399–414, 2020) Buoy and gauge measurements were recorded at the same locations and in identical sea states, allowing for a like-for-like comparison. We examine experiments with both following (unimodal in direction) and crossing (bimodal in direction) sea states. In addition to this, we use synthetic wave data to investigate the effects of wave generation and nonlinearity on spreading estimates. Our results show that while directional estimates produced using buoy measurements are reasonably accurate in following sea states, they struggle to identify distinct directional peaks in crossing sea states. We find that spreading estimates made using buoy measurements tend to underestimate the degree of directional spreading by approximately 9-14% in following sea states, which is most apparent in narrowly spread conditions.

A Model-Derived Empirical Formulation for Wave Run-Up on Naturally Sloping Beaches

A new set of empirical formulations has been derived to predict wave run-up at naturally sloping sandy beaches. They are obtained by fitting the results of hundreds of XBeach-NH+ model simulations. The simulations are carried out over a wide range of offshore wave conditions (wave heights ranging from 1 to 12 m and periods from 6 to 16 s), and surf zone (Dean parameters aD ranging from 0.05 to 0.30) and beach geometries (slopes ranging from 1:100 to 1:5). The empirical formulations provide estimates of wave set-up, incident and infragravity wave run-up, and total run-up R2%. Reduction coefficients are included to account for the effects of incident wave angle and directional spreading. The formulations have been validated against the Stockdon dataset and show better skill at predicting R2% run-up than the widely used Stockdon relationships. Unlike most existing run-up predictors, the relations presented here include the effect of the surf zone slope, which is shown to be an important parameter for predicting wave run-up. Additionally, this study shows a clear relationship between infragravity run-up and beach slope, unlike most existing predictors.

Total wave power absorption by a multi-float wave energy converter and a semi-submersible wind platform with a fast far field model for arrays

Wave energy converters absorb wave power by mechanical damping for conversion into electricity and multi-float systems may have high capture widths. The kinetic energy of the floats causes waves to be radiated, generating radiation damping. The total wave power absorbed is thus due to mechanical and radiation damping. A floating offshore wind turbine platform also responds dynamically and damping plates are generally employed on semi-submersible configurations to reduce motion, generating substantial drag which absorbs additional wave power. Total wave power absorption is analysed here by linear wave diffraction–radiation–drag models for a multi-float wave energy converter and an idealised wind turbine platform, with response and mechanical power in the wave energy case compared with wave basin experiments, including some directional spread wave cases, and accelerations compared in the wind platform case. The total power absorption defined by capture width is input into a far field array model with directional wave spreading. Wave power transmission due a typical wind turbine array is only reduced slightly (less than 5% for a 10 × 10 platform array) but may be reduced significantly by rows of wave energy converters (by up to about 50%).

The diagnostic role of ascitic fluid adenosine deaminase activity in a peritoneal tuberculosis case presenting with abdominal pain and diarrhea

A young case diagnosed with peritoneal tuberculosis with ascites will be presented here. Conditions that may pose a significant risk for the development of tuberculous peritonitis; poor hygiene, overpopulation, consumption of unpasteurized milk, cirrhosis, peritoneal dialysis, HIV infection, drug abuse and inadequate access to healthcare. In general, the tuberculosis agent reaches the gastrointestinal system via hematogenous route, ingestion of infected sputum, or direct spread. Peritoneal TB should be considered in the differential diagnosis in patients with abdominal pain, diarrhea, weight loss, anorexia, night sweats, presence of ascitic fluid, bilateral pleural effusion, pleural nodule appearance, and findings suggestive of peritonitis carcinomatosis, as in our case. Peritoneal tuberculosis is rarely diagnosed, without a high index of suspicion for this disease.

Vulvar Endometriosis by Suspected Spread Via the Round Ligament

Study Objective To present a rare case of vulvar endometriosis by suspected spread through the round ligament and review the literature regarding vulvar endometriosis. Design Case report. Setting Tertiary care hospital. Patients or Participants One patient. Interventions Patient with a painful 4 × 3 cm well-circumscribed, subcutaneous mobile mass on the left labia majora deep in the subcutaneous tissue with no overlying skin changes was worked up with CT-guided IR core biopsy that revealed endometriosis. Pelvic MRI revealed a fibroid uterus and 3.8 × 2.6 × 3.1 cm infiltrative soft tissue mass within the left mons pubis extending into the superior aspect of the left labia majora. The mass was noted to be contacting the distal aspect of the round ligament with resultant cyst in the canal of Nuck. Patient underwent laparoscopic myomectomy and local excision of the left vulvar mass for management. Measurements and Main Results Operative findings were consistent with endometrioma in the left vulva and endometriotic implant on the left round ligament at the insertion site into the inguinal canal. Pathology of both the left vulvar mass and excised left round ligament lesion revealed endometriosis. We suggest direct spread via the round ligament as the source of patient's vulvar endometriosis given these findings. Conclusion Spontaneous perineal and vulvar endometriosis is extremely rare, but in cases of clinically suspected vulvar endometriosis, the round ligament should be considered as the potential route of disease spread. Endometriosis should be suspected in extrapelvic lesions with observed cyclic response to the menstrual cycle and considerations should be given for diagnostic laparoscopy to look for pelvic disease in these cases. To present a rare case of vulvar endometriosis by suspected spread through the round ligament and review the literature regarding vulvar endometriosis. Case report. Tertiary care hospital. One patient. Patient with a painful 4 × 3 cm well-circumscribed, subcutaneous mobile mass on the left labia majora deep in the subcutaneous tissue with no overlying skin changes was worked up with CT-guided IR core biopsy that revealed endometriosis. Pelvic MRI revealed a fibroid uterus and 3.8 × 2.6 × 3.1 cm infiltrative soft tissue mass within the left mons pubis extending into the superior aspect of the left labia majora. The mass was noted to be contacting the distal aspect of the round ligament with resultant cyst in the canal of Nuck. Patient underwent laparoscopic myomectomy and local excision of the left vulvar mass for management. Operative findings were consistent with endometrioma in the left vulva and endometriotic implant on the left round ligament at the insertion site into the inguinal canal. Pathology of both the left vulvar mass and excised left round ligament lesion revealed endometriosis. We suggest direct spread via the round ligament as the source of patient's vulvar endometriosis given these findings. Spontaneous perineal and vulvar endometriosis is extremely rare, but in cases of clinically suspected vulvar endometriosis, the round ligament should be considered as the potential route of disease spread. Endometriosis should be suspected in extrapelvic lesions with observed cyclic response to the menstrual cycle and considerations should be given for diagnostic laparoscopy to look for pelvic disease in these cases.