Ultrasound Endometriosis Diagnosis
Endometriosis produces fibrosis, solid masses, cysts, liquid effusion and
inflammatory reaction. It may attach to virtually any structure including
uterus, ovaries, bowel, lungs, kidneys, etc. All this distorts the ultrasound
image.
I have found several ultrasound signs consistent with this condition, and
have been successfully detecting endometriosis by Ultrasound since 1984.
The leading endometriosis ultrasound signs I have found produce a diffuse
disorganization of the pelvic anatomy, making it difficult to recognize the
pelvic structures. These signs are:
- More interphases surrounding the uterus and ovaries
- Higher echogenecity around the uterus and ovaries
- Lower contrast
- Diffuse hypoechoic areas, surrounded by strong echogenic tissue
- Uterus malposition: retroflexion, retroversion, retrocession, lateral
displacement (alone or combined)
- Small low-level echo areas within the myometrium (adenomyosis)
- Hypoechoic or mixed pattern cysts
- Polycystic or microcystic ovaries
- Fixed uterus and ovaries (transvaginal sonography)
- Cull-de-sac abnormal effusion
- Ovarian enlargement
- Hypoechoic ovaries
- Pelvic vascular congestion
Although up to now sonography has not been useful in distinguishing pelvic
inflammatory disease from endometriosis, we can clinically rule out pelvic
inflammatory disease, as we must do before practicing laparoscopy, since this is
contraindication for laparoscopy
By reviewing hundreds of cases detected during these years, I found
endometriosis to be more frequent than we thought it was. We can also use
ultrasound to follow up the treatment, without any risk and as often as needed.
From Investigaciones Médicas, #48, Dr. Gonzalo Diaz M.
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