ULTRASOUND FEATURES OF OVARIAN ENDOMETRIOMAAND CORRELATION WITH SURGICAL FINDINGS
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Keywords
ovarian endometrioma, endometriosis, transvaginal ultrasound, laparoscopy, ovarian cyst, adhesions, surgical correlation
Abstract
Background: Ovarian endometrioma is a common manifestation of endometriosis and is frequently identified during evaluation of chronic pelvic pain, dysmenorrhea, infertility and adnexal masses. Transvaginal ultrasound (TVUS) is a first-line imaging modality and can demonstrate characteristic internal echoes, wall morphology, vascularity and associated pelvic abnormalities. Correlation with operative findings is useful for evaluating the ability of ultrasound to characterize disease extent.
Aim: To evaluate the ultrasound features of ovarian endometrioma and correlate sonographic findings with intraoperative findings in a 100-woman cohort.
Methods: One hundred women with suspected ovarian endometrioma on clinical and/or ultrasound evaluation were included. TVUS assessed cyst size, laterality, morphology, internal echoes, wall characteristics, vascularity, adhesions, reduced ovarian mobility and associated deep endometriosis. Operative findings were documented during laparoscopy/laparotomy, including endometrioma confirmation, adhesions, fixation, rupture/spillage, posterior cul-de-sac involvement and endometriosis elsewhere. Histopathology was reviewed where cyst-wall tissue was submitted.
Results: Mean age was 31.8 ± 6.4 years. Dysmenorrhea was present in 72%, chronic pelvic pain in 55% and infertility/subfertility in 29%. Bilateral endometriomas were identified sonographically in 34%. The commonest sonographic appearance was homogeneous low-level internal echoes (84%), followed by posterior acoustic enhancement (67%), thick/smooth cyst wall (61%) and absent internal vascularity (78%). Surgical confirmation of endometrioma occurred in 94 cases. Ultrasound correctly identified endometrioma in 88 of these 94 cases.
Conclusion: TVUS demonstrates a characteristic appearance of ovarian endometrioma and provides clinically useful information about laterality, size and associated adhesive disease. Correlation with operative findings is particularly valuable for assessing disease extent and planning minimally invasive surgery.
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