Cesarean scar endometriosis: Clinical presentation and imaging features with a focus on MRI

Abdomen, MR, CT, Diagnostic procedure, Obstetrics, Abscess, Haemorrhage Authors: A. S. Dumitrescu, T. Herold; Berlin/DE DOI: 10.1594/ecr2012/C-0505 Learning objectives Endometriosis is a common and important clinical problem of women, predominantly those in the reproductive age group. Endometriosis of the abdominal wall is less frequent and is mostly associated with cesarean section scars. It can pose diagnostic difficulties and should be in the differential diagnosis of abdominal wall lumps in females. The purpose of this exhibit is: 1. To review the clinical presentation and imaging findings of abdominal wall endometriosis with intramuscular as well as subcutaneous lesions following caesarian section; 2. To discuss diagnostic strategies...

Endometriosis was first described by Rokitansky in 1860 and is defined as the presence of endometrial glandular tissue outside of the uterus. Clinical presentation The most common symptoms are dysmenorrhea, dyspareunia, pelvic pain, and infertility, although only a minority of patients present with all the symptoms andmany patients are asymptomatic. Localization Frequent localizations in the pelvis include the ovaries, uterine ligaments, serosal surfaces, cul-de-sac, fallopian tubes, rectosigmoid, and urinary bladder (Fig. 1). [3] Extrapelvic endometriosis are bladder, kidney, bowel, omentum, lymph nodes, lungs, pleura, extremities,... Imaging findings OR Procedure details Imaging considerations Endometriosis, in patients with scars, is more common in the abdominal skin and subcutaneous tissue compared to muscle and fascia. Endometriosis involving only the rectus muscle and sheath is very rare. [7] In this unusual localization, clinical as well as initial imaging findings are likely to be misinterpreted by physicians and radiologists (e.g., as abscesses or malignant tumors). Along with the comparative rarity of the disease this leads to frequent overlooking of the correct diagnosis. [8,9,10] Usually, the initial imaging examination for suspected...

Endometriosis is a common and important clinical problem of women, predominantly those in the reproductive age group. The condition is associated with islands of ectopic endometrial tissue. Localization in the abdominal wall as presented above is rare and mostly associated with a cesarean section. Such lesions can mimic tumors of the soft tissue or hematomas of other origin. It is important to keep this rare differential diagnosis in mind and to inquire about any association of the clinical symptoms with the menstrual cycle, since the... Personal Information A.S. Dumitrescu, T. Herold Institut für Röntgendiagnostik HELIOS Klinikum Berlin-Buch Schwanebecker Chaussee 50 13125 Berlin, Germany You can e-mail the corresponding author at: [email protected]

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