Diagnostic Ultrasound - Abdomen and Pelvis

Endometrioma
(Left) Longitudinal
endovaginal US shows a large
right adnexal endometrioma
as a complex cystic mass ſt
with a thin wall and diffuse
homogenous low-level
internal echoes. The large
endometrioma displaces the
uterus inferiorly . (Right)
Transabdominal US shows a
large endometrioma ſt with
adjacent normal ovarian
stroma containing follicles.
Note echogenic foci with
"comet-tail" artifact st in the
wall of the endometrioma
from cholesterol deposits.
Diagnoses: Female Pelvis
(Left) Transverse
transabdominal US shows
bilateral endometriomas ſt.
In the cul-de-sac, a spiculated
mass representing deep
invasive endometriosis pulls
both ovaries together
posterior to the uterus (socalled
"kissing ovaries").
(Right) Endovaginal US in a
premenopausal woman
demonstrates a thick-walled
cystic mass with diffuse
internal echoes. The irregular
wall thickening is atypical ſt
and may be mistaken for
malignancy; the lack of
Doppler flow and clinical
history are helpful features.
(Left) Endovaginal US in a
woman presenting with acute
severe pelvic pain
demonstrates a large adnexal
complex cyst with
homogeneous low-level
internal echoes ſt, consistent
with endometrioma. Complex
free fluid is present
adjacent to the uterus .
(Right) Caudal laparoscopic
photo demonstrates the large
adnexal mass seen on
previous ultrasound. Note
leaked old blood
("chocolate fluid") into the
peritoneal space. Pathologic
findings confirmed ruptured
endometrioma.
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