Ultrasonography and Atypical Sites of Endometriosis

S. Guerriero, Francesca Conway, M. Pascual, B. Graupera, Silvia Ajossa, S. Ajossa, Manuela Neri, Eleonora Musa, Marcelo Pedrassani, Juan Luis Alcázar, Juan Luis Alcazar
Diagnostics · 2020 · vol. 10(6) , pp. 345 · doi:10.3390/diagnostics10060345 · PMID:32471042 · W3029655755
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Ultrasonography can identify endometriosis in atypical sites including scars, umbilicus, rectus muscle, inguinal region, perineum, appendix, liver, pancreas, kidney, diaphragm, and nerves by revealing characteristic hypoechoic or mixed solid/cystic lesions.

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Abstract

In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in "atypical" sites, in all the cases where "typical" clinical findings are present.

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endometriosisthoracic_endometriosis

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