Diagnosis of endometriosis 2nd part - Ultrasound diagnosis of endometriosis (adenomyosis, endometriomas, adhesions) in the community.

OBJECTIVE: To summarise the current knowledge and trends in the basic ultrasound diagnosis of adenomyosis, endometroid cysts and pelvic adhesions. DESIGN: Review article. SETTING: Centre for diagnostics and treatment of endometriosis and Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Department of Gynaecology and Obstetrics, Burton Hospitals NHS, United Kingdom. METHODS: Literature review. RESULTS: Endometriosis is a relatively common disease, which often escapes timely diagnosis, although sonographic features of adenomyosis, endometriomas and pelvic adhesions can be easily assessed on the basic ultrasound examination. Endometriomas are ovarian cysts in a premenopausal patient with ground glass echogenicity of the cyst fluid, one to four locules and no papilary projections with detectable blood flow. Adenomyosis is characterised by an asymmetrical thickening of the myometrium due to an ill-defined myometrial lesion with fan-shaped shadowing, non-uniform echogenicity with myometrial cysts, hyperechogenic islands, hyperechogenic subendometrial lines and buds with an irregular or interrupted junctional zone, and translesional vascularity containing vessels crossing the leasion perpendicular to the endometrium. Pelvic adhesions can be detected using dynamic aspect of ultrasound examination demonstrating negative sliding sign of the uterus and/or ovaries against surrounding tissue planes and site-specific tenderness. Distorted pelvic anatomy (the presence of uterine ‚question mark sign and/or ‚kissing ovaries) is another sign of adhesions. CONCLUSION: First step in basic transvaginal ultrasound is visualisation of the uterus and ovaries, assessment of their mobility and tenderness during examination. Knowledge of the characteristic ultrasound features of adenomyosis, endometriomas and adhesions enables timely diagnosis of endometriosis by the community gynecologist and prompt referral to the endometriosis centre.