Endometriosis gone wrong: imaging the complications

Genital / Reproductive system female, Pelvis, CT, MR, Ultrasound, Complications, Diagnostic procedure, Haemorrhage, Inflammation Authors: C. Rodrigues, T. B. Rodrigues, M. D. Santana, I. Reis, A. Guerra DOI: 10.26044/ecr2026/C-29290 Learning objectives To illustrate and review the imaging findings of complications associated with endometriosis, including endometrioma rupture, ovarian torsion, malignant transformation, decidualization, pelvic inflammatory disease (PID), acute bowel obstruction, haemorrhagic ascites, hydronephrosis and catamenial pneumothorax.

Endometriosis is a chronic inflammatory disease affecting up to 10% of women of reproductive age. The disease is characterised by functional endometrial tissue located beyond the endometrium, causing inflammation and fibrosis.1Although chronic pelvic pain and infertility are the most frequently reported symptoms, endometriosis is associated with a wide spectrum of potentially severe complications, some of which may present as acute or life-threatening emergencies.1 Findings and procedure details Ruptured EndometriomasRuptured endometriomas are a rare condition, affecting approximately 3% of endometriotic cysts in patients of reproductive age, occurring most frequently during pregnancy or following abdominal/pelvic trauma.2,3Imaging findings include a cyst with heterogeneous content and a thickened, irregular, and enhancing wall with parietal discontinuity. Associated hemoperitoneum is seen as heterogeneous free fluid content on US and as a hyperintense collection on T1-weighted imaging (WI).3,4[Fig 1][Fig 2]Ovarian TorsionAdnexal torsion is a surgical emergency from rotation of the ovary and/or fallopian tube around its vascular pedicle.5 Although...

Endometriosis is a multisystem disease with a broad spectrum of potentially severe and emergent complications that extend far beyond its classical pelvic manifestations. Recognition of their characteristic imaging patterns across different modalities is essential for radiologists to ensure early diagnosis, accurate differentiation from mimicking conditions, and appropriate triage. Timely radiological identification directly influences clinical decision-making, guides multidisciplinary management, and plays a pivotal role in preventing delayed treatment, irreversible organ damage, and life-threatening outcomes. Personal information and conflict of interest C. Rodrigues: Nothing to disclose T. B. Rodrigues: Nothing to disclose M. D. Santana: Nothing to disclose I. Reis: Nothing to disclose A. Guerra: Nothing to disclose

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