Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics

Abstract

Objectives To describe the sonographic and clinical features of abdominal wall endometriosis (AWE), a frequently misdiagnosed condition. Methods

Abdominal Wall Endometrioma: Ultrasonographic Features and Correlation with Clinical Findings

“…With the exception of lipomas, which can be recognised more confidently, sonography is not able to distinguish benign lesions from malignant ones. The sonographic appearance of abdominal wall endometrioma can be cystic, multicystic, mixed, or solid (12). The echo pattern may or may not correlate with the menstrual period, and sonographic findings are nonspecific (13).…”

“…Furthermore, it is insufficient for specific diagnosis. AWE cannot be distinguished from invasive abdominal masses by CT (12,14,17). Although, typically, MRI is suited best for defining the anatomy of the soft tissue mass and its surrounding structures, the signal characteristics and contrast enhancement pattern of AWE are not specific, and the true histological nature of the tumour or other soft-tissue masses often cannot be ascertained by imaging alone, with few exceptions (e.g., lipoma or haemorrhage) (13,18).…”

Abdominal wall endometriosis: an update in clinical, imagistic features, and management options

“…Regarding the scanning technique, proper magnification is recommended of the image to reduce the field of view to 3-5 cm in depth [36]. It is important first to identify on a transverse or longitudinal section the normal abdominal layers of the abdominal wall far from the site where the AWE is suspected.…”

“…The peritoneal fat located underneath the muscular layer can help in identifying the peritoneum. Then, sliding the probe while exerting slight pressure will help to locate the AWE, as a result of the pain induced [36]. Usually AWE appears on two-dimensional ultrasound as a nonhomogeneous hypoechoic mass with echogenic spots or thick echogenic strands that represent a fibrotic component in the abdominal wall (fig 1a) [24].…”

“…The mass infiltrates the surrounding tissue due to an inflammatory reaction triggered by the monthly hemorrhage in this tissue [37]. A hyperechoic ring can be observed at the periphery of the nodule, and on histology, it represents edematous adipose tissue filled with cells of inflammatory origin (histiocytes and granulocytes) [36]. The echogenic patterns are dependent on the haemorrhagic and fibrous components of the lesions and on the phase of the patient's menstrual cycle [38].…”