I-42: Cardinal Manifestations of Endometriosis Transvaginal Ultrasound

Endometriosis is a common benign gynecologic disorder, defined by endometrial glands and stroma outside of the endometrial cavity. The three primary types of endometriosis are superficial peritoneal lesions, ovarian endometriomas, and deep infiltrating endometriosis (DIE).Although laparoscopy continues to be the gold standard for the diagnosis of endometriosis, transvaginal ultrasonography showed important role for the non-invasive diagnosis of endometriosis. In this abstract the most common indirect ultrasound-based markers/ finding s (pelvic adhesions, endometrioma, and echogenic lesions) would be assessed. Although ultrasound is poor at detecting adhesions, it is able to dynamically assess mobility and fixation. The presence of one of the following findings can be considered to indicate the likelihood of pelvic adhesions: (a) blurring of the margins of the ovary (margins), and adhesion of the ovary to the uterus ((b) ‘fixation’ and (c) distance of the ovary from the probe. The most common organs affected by endometriotic deposits are the ovaries. Although there is some variation in the sonographic appearance of endometriomas, the classic endometrioma is a homogenous, focal lesions with low level echos, they may be uni or multilocular, containing thin or thick septations and may contain wall nodules. Ultrasound is also predominantly used to evaluate ovaries by detecting the pinpoint focal lesions with low level echos. The use of simple ultrasonographic findings, e.g. adhesion of the ovary to the uterus, distance from the probe, presence of pinpoint focal lesions and the classic features of endometrioma allow appropriate patient counselling of further diagnostic or therapeutic interventions and to reduce the number of unnecessary laparoscopies. Our experience suggest that the inclusion of ovarian margins, mobility, and fixation as indirect ultrasound-based markers of pelvic pathology improves our ability to predict or exclude the presence of pelvic adhesion due to endometriosis lesions.