{"paper_id":"cbe0be5e-9b4b-4b43-97c5-38c61e48782b","body_text":"69\nIntroduction\nEndometrioma is a well circumscribed mass of endometriosis \nthat occurs when ectopic endometrial tissue (gland and stroma), \nwhich can respond to ovarian hormonal stimulation, grows outside \nthe uterus [1]. Endometrioma in a surgical scar develops in 0.1% \nof women who have undergone cesarean section, and 25% of these \nwomen have concomitant pelvic endometriosis [2]. Its clinical \ndiagnosis in the abdominal wall has been confused with abscess, \nlipoma, hematoma, sebaceous cyst, suture granuloma, inguinal \nhernia, incisional hernia, desmoid tumor, sarcoma, lymphoma, or \nprimary and metastatic cancer [2,3]. The diagnosis of abdominal \nwall endometriomas is often confused with other surgical \nconditions. Endometriosis is rarely seen by general surgeons and \nis often diagnosed on histological examination postoperatively [3]; \nbecause of the large number of potential pitfalls in its diagnosis, we \npresent a case as seen from the perspective of a general surgeon \nand also by gynecologists emphasizing a new diagnosis image by \nskin infrared thermography. Vessels in the skin are arranged into \nsuperficial and deep horizontal plexuses and they are involved \nin thermoregulation, oxygen and nutritional support. The skin \nhas a large number of functions and broad appeal spanning basic \nmechanistic and clinical research. Indeed, the skin can be used as \na marker of normal and impaired vascular control and, owing to \nits accessibility and frequent involvement, is easy to investigate \nnon-invasively. The measurement of skin temperature provides an \nindirect measure of blood flow and can be measured by assessing \nthermal convection or directly measuring skin temperature \n(using thermography) [4]. The technology of thermal imaging \nhas made significant advances in recent years. It has been used in  \nmilitary applications widespread, but not in clinical medicine [5]. \nThermography is a diagnostic method which measures temperature  \n \ndifferences across the skin surface using a highly sensitive infrared \ncamera. Recent development of digital infrared thermographic \nfocal plane array cameras offers the opportunity to revitalize this \ndiagnostic method and further improve its accuracy. \nCurrently, there is no consensus regarding diagnostic \nparameters for digital thermography in diagnosis of scar \nendometriosis. The aim of this paper is to examine the application \nof digital thermography and propose endometriosis diagnostic \nthermographic as compared to other modalities of exams. We report \na case of scar endometriosis in a woman who underwent caesarean \nsection diagnose by alteration in thermograph assessment.\nCase Report (MIC, 33 years old)\nAfter 2 years of a cesarean section, a 33-year-old white woman \npresented with a 12-month history of pain in the lower right \nquadrant in the suprapubic region at the site of a Pfannenstiel-type \nlaparotomy. On physical examination she had a 3-cm nodule on \nthe cesarean scar, causing pain during menstruation. Ultrasound \nshowed the presence of an oval-shaped hypoecogenous neo-\nformation (Figure 1). A cytological examination indicated a cystic \nneo-formation removed under regional anesthesia [6]. The neo-\nformation was firmly attached to the fascia of the rectus abdominalis \nmuscle. Histological examination showed numerous endometriotic \nfoci spread in an abundant fibrous tissue. They were characterized \nby glands in frequent cystic dilation. The glands were surrounded \nby a variable amount of endometrial stroma with extensive \ndecidual changes this pattern was consistent with a secretory \nphase of the menstrual cycle. The patient was submitted to an \ninfrared thermography: the woman case was kept in a warm room \nwith temperature at 22-24 °C up to 15min. Patient complaining of a \nFrancisco das Chagas Medeiros*, Francisco Eristow Nogueira, Vietla S Rao and Dalgimar B de Menezes\nDepartment of Gynecology, Federal University of Ceará, Brazil\n*Corresponding author: FC Medeiros, Department of Gynecology, Assis Chateaubriand School Maternity, Faculty of Medicine, Federal University of \nCeará, Rua Prof Costa Mendes 1608, 2nd Floor, 60416-200 Fortaleza, Ceará, Brazil\nSubmission: \n  September 09, 2017; Published: \n  January 10, 2018  \nInfrared Thermography Appearance of Abdominal \nWall Endometriosis: A Useful Tool for Diagnosis\nResearch Article                                               \nCopyright © All rights are reserved by FC Medeiros.\nCRIMSONpublishers\nhttp://www.crimsonpublishers.com\nAbstract\nCase reports are significant part of the medical literature that continues to have their place in scientific journals. Recurrently they are the first \nevidence for new diagnosis and other medical conducts. Original and critical use of these studies can increase their values by elevating the practice of \nmedicine. We present a new useful tool for diagnosing abdominal wall endometriosis through a teletermography in a 33 year old woman comparing \nwith magnetic resonance and physical exam and pathological histology. \nKeywords: Endometriosis; Scar endometrioma; Infrared thermography\nISSN: 2577-2015\n\nHow to cite this article: Francisco d C M, Francisco E N, Vietla S R, Dalgimar B d M. Infrared Thermography Appearance of Abdominal Wall Endometriosis: A \nUseful Tool for Diagnosis. Gynecol Res Women’s Health. 1(4). IGRWH.000518: 2018. DOI: 10.31031/IGRWH.2018.01.000518\n70\nInvest Gynecol Res Women’s HealthInvestigations in Gynecology Research & Womens Health\nheavy pain in right-low abdomen was asked to hold up her pending \nabdomen for 10min. Then thermograms of the abdomino-pelvic \nwall were taken by using an E-25 digital infrared video camera \n(sensitivity at 0.2 °C; Flir Systems with data analyzing software Quick \nView 2) positioned at a 1.5m far from the pelvis which provides the \nthermo pictures and reads the temperatures without touching the \nsubject. All the data were collected in a computer. A hot area (Ar1 - \nwhite colored with black dots) showing temperatures from 34.0 °C \nto 35.4 °C, was spotted on the skin over the right inguinal ligament, \nand considered hyperthermic, when compared to the same opposite \nregion, used as control, showing temperatures from 32.4 °C-33.7 °C \n(Figure 2). Thermographic studies use the ipsilateral parts of the \nbody scanning as self-control, as well as the sudden variations of \ntemperature (±0.6 °C) to determine hyperthermic or hypothermic \nareas. These temperatures gradients are out of our skin heat \nperception and Thermographic scanning made it possible to find \nthe hyperthermia area.\nFigure 1: Panel A.\nFigure 2: Panel B.\nThe surgical approach was through surgical incision and \nexeresis of the endometrioma (Figure 3). At the Panel 3 one may \nsee the macroscopic and microscopic diagnosis of endometriosis by \nfindings by viewing endometrial glands and stroma.\nFigure 3: Panel C.\nDiscussion and conclusion\nThe imaging modalities are non-specific but useful in \ndetermining the extent of the disease and planning of operative \nresection, especially in recurrent and large endometriosis lesions \nsuspicion. Compared with ultra-sonography, the theletermography \nis less invasive; it needs no physical contact between the probe and \nthe skin of the patient, thus avoiding discomfort, possible physical \ntrauma, and psychological embarrassment. It has the advantage of \ndetecting minimal nodular alterations. Our experience in selected \ncases leads us to believe that theletermogrphy was as a good \nmethod to the diagnosis of varicocele as well as to endometriosis, \nespecially for those patients who are mildly symptomatic or who \nhave no symptoms [7].\nReferences\n1. Koger KE, Shatney CH, Hodge K, McClenathan JH (1993) Surgical scar \nendometrioma. Surg Gynecol Obstet 177(3): 243-246.\n2. Singh KK, Lessells AM, Adam DJ, Jordan C, Miles WF, et al. (1995) \nPresentation of endometriosis to general surgeons: a 10-year experience. \nBr J Surg 82(10): 1349-1351.\n3. Seydel AS, Sickel JZ, Warner ED, Sax HC (1996) Extraplevic endometriosis: \ndiagnosis and treatment. Am J Surg 171(2): 239-241.\n4. Wright CI, Kroner CI, Draijer R (2006) Non-invasive methods and stimuli \nfor evaluating the skin’s microcirculation. J Pharmacol Toxicol Methods \n54(1): 1-25.\n5. Izhar, LilaI Z, Petrou, Maria (2012) Thermal imaging in medicine in \nadvances in imaging and electron physics. 171: 41-114.\n6. Medeiros FC, Cavalcante DI, Medeiros MA, Eleutério J (2011) Fine needle \naspiration cytology of scar endometriosis: Study of seven cases and \nliterature review. Diagn Cytopathol 39(1): 18-21.\n7. Nogueira FE, Medeiros FD, Barroso LV, Miranda EP , de Castro JD, et al. \n(2009) Infrared digital telethermography: a new method for early \ndetection of varicocele. Fertil Steril 92(1): 361-362.","source_license":"CC0","license_restricted":false}