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:

1. More interphases surrounding the uterus and ovaries
2. Higher echogenecity around the uterus and ovaries
3. Lower contrast
4. Diffuse hypoechoic areas, surrounded by strong echogenic tissue
5. Uterus malposition: retroflexion, retroversion, retrocession, lateral displacement (alone or combined)
6. Small low-level echo areas within the myometrium (adenomyosis)
7. Hypoechoic or mixed pattern cysts
8. Polycystic or microcystic ovaries
9. Fixed uterus and ovaries (transvaginal sonography)
10. Cull-de-sac abnormal effusion
11. Ovarian enlargement
12. Hypoechoic ovaries
13. 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.

Please, review the next article about endometriosis, ultrasound and laparoscopy.

From Investigaciones Médicas, #48, Dr. Gonzalo Diaz M.