Abstract
Endometriosis is the presence and growth of the glands and stroma of the lining of the uterus in an aberrant or heterotopic location. It is benign, but in many women, it is a progressive disease. The prevalence of endometriosis has been suggested to be 10% of women and is found predominantly in women of childbearing age. Symptoms of endometriosis are nonspecific, but the most common symptom is pelvic pain. The cause of endometriosis is uncertain and may involve retrograde menstruation, metaplasia. There are three phenotypes of endometriosis that include ovarian endometrioma, superficial peritoneal endometriosis, and deep infiltrative endometriosis (DIE). The extent of diseases varies considerably from isolated peritoneal lesions to widespread pelvic adhesions, infiltrating lesions, and ovarian cysts. Laparoscopy is only recommended in patients with negative imaging results and/or unsuccessful or inappropriate empirical treatment. However, a wide range of imaging modalities have gained a significant role in ruling out other pelvic diseases and may suggest the presence of endometriosis in the pelvis.
Similar content being viewed by others
Suggested Readings
Bazot M, Darai E, Hourani R, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232:379–89.
Bennett GL, Slywotzky CM, Cantera M, et al. Unusual manifestations and complications of endometriosis: spectrum of imaging findings channels review. AJR Am J Roentgenol. 2010;194 Suppl 6:WS34–46.
Caramella T, Novellas S, Fournol M, et al. Deep pelvic endometriosis: MR imaging features. J Radiol. 2008;89:473–9.
Carbognin G, Guarise A, Minelli L, et al. Pelvic endometriosis: US and MRI features. Abdom Imaging. 2004;29:609–18.
Choudhary S, Fasih N, Papadatos D, et al. Unusual imaging appearances of endometriosis. AJR Am J Roentgenol. 2009;192:1632–44.
Chung SY, Kim SJ, Kim TH, et al. Computed tomography findings of pathologically confirmed pulmonary parenchymal endometriosis. J Comput Assist Tomogr. 2005;29:815–8.
Cocco G, Delli Pizzi A, Scioscia M, Ricci V, Boccatonda A, Candeloro M, Tana M, Balconi G, Romano M, Schiavone C. Ultrasound Imaging of Abdominal Wall Endometriosis: A Pictorial Review. Diagnostics (Basel). 2021;11(4):609.
Frate CD, Girometti R, Pittino M, et al. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006;26:1705–18.
Hensen JJ, Van Breda Vriesman AC, Puylaert JBCM. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol. 2006;186:616–20.
Hoffbeck A, Hamid D, Meyer C, et al. Endometriosis of the round ligament revealed by an intermittent hernia. Gynecol Surg. 2006;3:295–7.
Jaramillo-Cardoso A, Shenoy-Bhangle AS, VanBuren WM, Schiappacasse G, Menias CO, Mortele KJ. Imaging of gastrointestinal endometriosis: what the radiologist should know. Abdom Radiol (NY). 2020;45(6):1694–710.
Kataoka ML, Togashi K, Yamaoka T, et al. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005;234:815–23.
Kinkel K, Chardonnens D. Endometriosis. In: Hamm B, Forstner R, editors. MRI and CT of the female pelvis. New York: Springer; 2007. p. 265–73.
Kinkel K, Frei KA, Balleyguier C, et al. Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2006;16:285–98.
Kirkpatrick A, Reed CM, Bui-Mansfield LT, et al. Endometriosis of the canal of Nuck. AJR Am J Roentgenol. 2006;186:56–7.
Lee YR, Choi YW, Jeon SC, et al. Pleuropulmonary endometriosis: CT–pathologic correlation. AJR Am J Roentgenol. 2006;186:1800–1.
Moro F, Leombroni M, Testa AC. Ultrasound Imaging in Endometriosis. Obstet Gynecol Clin North Am. 2019;46(4):643–59.
Patel MD, Feldstein VA, Chen DC, et al. Endometriosis: diagnostic performance of US. Radiology. 1999;210:739–45.
Quesada J, Härmä K, Reid S, Rao T, Lo G, Yang N, Karia S, Lee E, Borok N. Endometriosis: A multimodal imaging review. Eur J Radiol. 2023;158:110610.
Rogerio AL. Endometriosis: etiology, pathology, diagnosis, management. In: Katz VL, Lobo RA, Lentz G, Gershenson D, editors. Comprehensive gynecology. 5th ed. Philadelphia: Elsevier; 2007. p. 473–95.
Rousset P, Florin M, Bharwani N, Touboul C, Monroc M, Golfier F, Nougaret S, Thomassin-Naggara I, ENDOVALIRM Group. Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging. 2023;104(3):95–112.
Sakala MD, Jha P, Tong A, Taffel MT, Feldman MK. MR imaging of endometriosis of the adnexa. Magn Reson Imaging Clin N Am. 2023;31(1):121–35.
Takeuchi M, Matsuzki K, Uehara H, et al. Malignant transformation of pelvic endometriosis: MR imaging findings and pathologic correlation. Radiographics. 2006;26:407–17.
Tanaka YO, Yoshizako T, Nishida M, et al. Ovarian carcinoma in patients with endometriosis: MR imaging findings. AJR Am J Roentgenol. 2000;175:1423–30.
Testini V, Eusebi L, Grechi G, et al. Imaging of endometriosis: the role of ultrasound and magnetic resonance. Curr Radiol Rep. 2022;10:21–39.
Umaria N, Olliff JF. Pictorial review: imaging features of pelvic endometriosis. Br J Radiol. 2001;74:556–62.
Vora DJ, Majmudar R, Ajgaonkar HS. Spontaneous rupture of an endometriotic cyst. J Obstet Gynecol Ind. 2004;54(6):593.
Woodward PJ, Sohaey R, Mezzetti TP Jr, et al. Endometriosis: radiologic–pathologic correlation. Radiographics. 2001;21:193–216.
References
Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, et al. European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27:2765–75.
Carfagna P, De Cicco NC, De Cicco NA, et al. Role of transvaginal ultrasound in evaluation of ureteral involvement in deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2018;51:550–5.
Cocco G, Ricci V, Boccatonda A, Schiavone C. Focused ultrasound for the diagnosis of non-palpable endometriotic lesions of the abdominal wall: a not-uncommon surgical complication. J Ultrasound. 2020;23:183–7.
Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, Spadola S, Caltabiano R, Iraci M, Basile A, Milone P, Cianci A, Ettorre GC. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging. 2018;9(2):149–72.
Frühauf F, Fanta M, Burgetová A, Fischerová D. Endometriosis in pregnancy – diagnostics and management. Ceska Gynekol. 2019;84(1):61–7.
Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW, Krentel H, Janschek E, Exacoustos C, Malzoni M, Mueller M, Roman H, Condous G, Forman A, Jansen FW, Bokor A, Simedrea V, Hudelist G. The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand. 2021;100(7):1165–75.
Mamah JE, Ruth Otu C, Okafor CC, Okafor CG. Spontaneous haemoperitoneum in pregnancy in women with endometriosis: diagnostic challenges and management strategies. SAGE Open Med. 2024:12. https://doi.org/10.1177/20503121241243245.
Ottolina J, De Stefano F, Viganò P, Ciriaco P, Zannini P, Candiani M. Thoracic endometriosis syndrome: association with pelvic endometriosis and fertility status. J Minim Invasive Gynecol. 2017;24(3):461–5.
Reid S, Leonardi M, Lu C, Condous G. The association between ultrasound-based ‘soft markers’ and endometriosis type/location: a prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2019;234:171–8.
Rindos NB, Mansuria S. Diagnosis and management of abdominal wall endometriosis: a systematic review and clinical recommendations. Obstet Gynecol Surv. 2017;72(2):116–22.
Robinson KA, Menias CO, Chen L, Schiappacasse G, Shaaban AM, Caserta MP, Elsayes KM, VanBuren WM, Bolan CW. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol (NY). 2020;45(6):1762–75.
Sud S, Buxi TBS, Sheth S, Ghuman SS. Endometriosis and its myriad presentations: magnetic resonance imaging-based pictorial review. Indian J Radiol Imaging. 2021;31(1):193–202.
Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010;35(6):730–40.
Yoon JH, Choi D, Jang KT, Kim CK, Kim H, Lee SJ, Chun HK, Lee WY, Yun SH. Deep rectosigmoid endometriosis: “mushroom cap” sign on T2-weighted MR imaging. Abdom Imaging. 2010;35(6):726–31.
Competing Interest Declaration
The author(s) has no competing interests to declare that are relevant to the content of this manuscript.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2025 Springer Nature Singapore Pte Ltd.
About this entry
Cite this entry
Lee, H., Cho, J.Y. (2025). Endometriosis. In: KIM, S.H. (eds) Gynecologic Imaging. Springer, Singapore. https://doi.org/10.1007/978-981-99-2955-9_15-1
Download citation
DOI: https://doi.org/10.1007/978-981-99-2955-9_15-1
Received:
Accepted:
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-99-2955-9
Online ISBN: 978-981-99-2955-9
eBook Packages: Living Reference MedicineReference Module Medicine