Endometriosis: imaging spectrum of unusual locations and atypical presentations

Endometriosis is a chronic, estrogen-dependent inflammatory disease defined by the presence of endometrial-like tissue outside the uterus, affecting approximately 10% of women of reproductive age as well as a notable proportion of adolescents and postmenopausal patients. Although traditionally considered a pelvic disorder, it is increasingly recognized as a multisystem condition with a broad spectrum of extrapelvic locations and atypical clinical and imaging presentations, which contribute to significant diagnostic delay. This review provides a comprehensive overview of the imaging spectrum of endometriosis beyond the pelvis, emphasizing the central role of magnetic resonance imaging (MRI) in lesion detection, characterization, and preoperative mapping. Particular attention is given to the diverse manifestations of extrapelvic disease, including gastrointestinal, genitourinary, thoracic, musculoskeletal, and neural involvement, each of which may present with nonspecific or misleading findings and mimic other pathological entities. Additionally, uncommon presentations such as infection, malignant transformation, and decidualization, as well as variations across different patient populations, further increase diagnostic complexity. Recognizing these patterns and understanding their imaging features are essential to avoid misdiagnosis and delays in care. A systematic approach combining clinical suspicion, tailored imaging protocols, and structured reporting is key to improving diagnostic accuracy and guiding appropriate management. Greater awareness of the multisystem nature of endometriosis is crucial to optimize patient outcomes and reduce the burden of this frequently underrecognized disease. Graphical abstract Similar content being viewed by others Data availability No datasets were generated or analysed during the current study. Abbreviations - ADC: - Apparent diffusion coefficient - CT: - Computed tomography - DIE: - Deep infiltrating endometriosis - DWI: - Diffusion-weighted imaging - EAOC: - Endometriosis-associated ovarian cancer - ESUR: - European Society of Urogenital Radiology - FS: - Fat-suppressed - GU: - Genitourinary - IBD: - Inflammatory bowel disease - IVIM: - intravoxel incoherent motion - MRI: - Magnetic resonance imaging - O-RADS MRI: - Ovarian-Adnexal Reporting and Data System magnetic resonance imaging - OHVIRA: - Obstructed Hemivagina and Ipsilateral Renal Anomaly - SAR: - Society of Abdominal Radiology - SE: - Superficial peritoneal endometriosis - T1WI: - T1-weighted images - T2WI: - T2-weighted images - TES: - Thoracic endometriosis syndrome - TVUS: - Transvaginal ultrasound - US: - Ultrasound

Tomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, Horne AW, et al. An international terminology for endometriosis, 2021. Hum Reprod Open 2021;2021. https://doi.org/10.1093/hropen/hoab029. As-Sanie S, Mackenzie SC, Morrison L, Schrepf A, Zondervan KT, Horne AW, et al. Endometriosis. JAMA 2025;334:64. https://doi.org/10.1001/jama.2025.2975. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. The Lancet 2021;397:839–52. https://doi.org/10.1016/S0140-6736(21)00389-5. Janssen EB, Rijkers ACM, Hoppenbrouwers K, Meuleman C, D’Hooghe TM. Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: A systematic review. Hum Reprod Update 2013;19:570–82. https://doi.org/10.1093/humupd/dmt016. Ladanyi C, Boyd S, Sticco P, Mohling S. Postmenopausal endometriosis, where are we now? Curr Opin Obstet Gynecol 2019;31:267–78. https://doi.org/10.1097/GCO.0000000000000548. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019;220:354.e1-354.e12. https://doi.org/10.1016/j.ajog.2018.12.039. Burk KS, Arif-Tiwari H, Chawla T, Dave HB, Franco IP, Causa-Andrieu P, et al. Imaging of endometriosis-related infertility. Abdom Radiol (NY) 2025;50:4960–70. https://doi.org/10.1007/s00261-025-04926-8. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020;382:1244–56. https://doi.org/10.1056/NEJMra1810764. VanBuren W, Feldman M, Shenoy-Bhangle AS, Sakala MD, Young S, Chamie LP, et al. Radiology State-of-the-art Review: Endometriosis Imaging Interpretation and Reporting. Radiology 2024;312:e233482. https://doi.org/10.1148/radiol.233482 Chamié LP, Ribeiro DMFR, Tiferes DA, Macedo Neto AC de, Serafini PC. Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings. RadioGraphics 2018;38:309–28. https://doi.org/10.1148/rg.2018170093. Feldman MK, Wasnik AP, Adamson M, Dawkins AA, Dibble EH, Jones LP, et al. ACR Appropriateness Criteria® Endometriosis. J Am Coll Radiol 2024;21:S384–95. https://doi.org/10.1016/j.jacr.2024.08.017. Thomassin-Naggara I, Dolciami M, Chamie LP, Guerra A, Bharwani N, Freeman S, et al. ESUR consensus MRI for endometriosis: protocol, lexicon, and compartment-based analysis. Eur Radiol 2025;35:7272–86. https://doi.org/10.1007/s00330-025-11611-3. Rousset P, Rousset-Jablonski C, Alifano M, Mansuet-Lupo A, Buy J-N, Revel M-P. Thoracic endometriosis syndrome: CT and MRI features. Clin Radiol 2014;69:323–30. https://doi.org/10.1016/j.crad.2013.10.014. Colak C, Chamie LP, Youngner J, Forney MC, Luna Russo MA, Gubbels A, VanBuren WM, Feldman M. MRI Features of Pelvic Nerve Involvement in Endometriosis. Radiographics. 2024;44(1):e230106. https://doi.org/10.1148/rg.230106. Shenoy-Bhangle AS, Movilla PR, Joyce S, Ghosh S, Goldstone RN, Kilcoyne A, et al. The Role of MRI in Diagnosis and Pre‐Surgical Mapping of Endometriosis. J Magn Reson Imaging 2026;63:39–59. https://doi.org/10.1002/jmri.70039. Tong A, VanBuren WM, Chamié L, Feldman M, Hindman N, Huang C, et al. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol (NY) 2020;45:1569–86. https://doi.org/10.1007/s00261-020-02483-w. Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, et al. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology. 2024;311(1):e232191. https://doi.org/10.1148/radiol.232191. Dave HB, Chamié LP, Young SW, Sakala MD, VanBuren WM, Jha P, et al. Bowel Endometriosis: Systematic Approach to Diagnosis with US and MRI. RadioGraphics 2025;45. https://doi.org/10.1148/rg.240102. Arkoudis N-A, Moschovaki-Zeiger O, Prountzos S, Spiliopoulos S, Kelekis N. Caesarean-section scar endometriosis (CSSE): clinical and imaging fundamentals of an underestimated entity. Clin Radiol 2023;78:644–54. https://doi.org/10.1016/j.crad.2023.05.020. Najdawi M, Razakamanantsoa L, Mousseaux C, Bendifallah S, Touboul C, Thomassin-Naggara I, et al. Resolution of Pain after Percutaneous Image-Guided Cryoablation of Extraperitoneal Endometriosis. J Vasc Interv Radiol 2023;34:1192–8. https://doi.org/10.1016/j.jvir.2023.03.025. Nezhat C, Amirlatifi N, Najmi Z, Tsuei A. Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management. J Clin Med 2024;13:7602. https://doi.org/10.3390/jcm13247602. Ryan C, Burns M, Redahan L. Endometriosis-associated obstructive uropathy: A case report. SAGE Open Med Case Rep 2025;13. https://doi.org/10.1177/2050313X251321671. Bazot M, Kermarrec E, Bendifallah S, Daraï E. MRI of intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol 2021;71:51–63. https://doi.org/10.1016/j.bpobgyn.2020.05.013. Agely A, Bolan C, Metcalfe A, VanBuren W, Menias C. Genitourinary manifestations of endometriosis with emphasis on the urinary tract. Abdom Radiol (NY) 2020;45:1711–22. https://doi.org/10.1007/s00261-019-02383-8. Piriyev E, Schiermeier S, Römer T. Bladder Endometriosis: Diagnostic, Therapy, and Outcome of a Single-Center Experience. Diagnostics 2025;15:466. https://doi.org/10.3390/diagnostics15040466. Shenoy-Bhangle AS, Pires Franco I, Ray LJ, Cao J, Kilcoyne A, Horvat N, et al. Imaging of Urinary Bladder and Ureteral Endometriosis with Emphasis on Diagnosis and Technique. Acad Radiol 2024;31:3659–71. https://doi.org/10.1016/j.acra.2023.10.053. Xiao L, White D, Kruger LF, Alwatari Y, Blackmon S, Burnett T, et al. Thoracic endometriosis syndrome: imaging findings and the value of a dedicated MRI protocol. Abdom Radiol (NY) 2025;50:4423–36. https://doi.org/10.1007/s00261-025-04835-w. Ye H, Shen C, Quan Q, Xi M, Li L. Endometriosis of the skeletal muscular system (ESMS): a systematic review. BMC Womens Health 2023;23:37. https://doi.org/10.1186/s12905-023-02184-8. Alimi Y, Iwanaga J, Loukas M, Tubbs RS. The Clinical Anatomy of Endometriosis: A Review. Cureus 2018. https://doi.org/10.7759/cureus.3361. Poudel D, Acharya K, Dahal S, Adhikari A. A case of scar endometriosis in cesarean scar: A rare case report. Int J Surg Case Rep 2023;102:107852. https://doi.org/10.1016/j.ijscr.2022.107852. Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, et al. Endometriosis of Abdominal and Pelvic Wall Scars: Multimodality Imaging Findings, Pathologic Correlation, and Radiologic Mimics. RadioGraphics 2012;32:2031–43. https://doi.org/10.1148/rg.327125024. Dadhwal V, Sharma A, Khoiwal K, Nakra T. Episiotomy scar endometriosis. Med J Armed Forces India 2018;74:297–9. https://doi.org/10.1016/j.mjafi.2017.06.004. Zhao L, Wang P, Zhao F, Wu W. A Case of Psoas Muscle Endometriosis: A Distinct Approach to Diagnosis and Management. J Minim Invasive Gynecol 2018;25:1305–8. https://doi.org/10.1016/j.jmig.2018.03.036. Ding Y, Gibbs J, Xiong G, Guo S, Raj S, Bui MM. Endometriosis Mimicking Soft-Tissue Neoplasms: A Potential Diagnostic Pitfall. Cancer Control 2017;24:83–8. https://doi.org/10.1177/107327481702400114. Mason BR, Chatterjee D, Menias CO, Thaker PH, Siegel CL, Yano M. Encyclopedia of endometriosis: a pictorial rad-path review. Abdom Radiol (NY) 2020;45:1587–607. https://doi.org/10.1007/s00261-019-02381-w. Siquara De Sousa AC, Capek S, Amrami KK, Spinner RJ. Neural involvement in endometriosis: Review of anatomic distribution and mechanisms. Clin Anat 2015;28:1029–38. https://doi.org/10.1002/ca.22617. Pham M, Sommer C, Wessig C, Monoranu C-M, Pérez J, Stoll G, et al. Magnetic resonance neurography for the diagnosis of extrapelvic sciatic endometriosis. Fertil Steril 2010;94:351.e11-351.e14. https://doi.org/10.1016/j.fertnstert.2009.12.046. Bourg J, Ruaux E, Bolze PA, Gavrel M, Charlot M, Golfier F, et al. Pelvic nerve endometriosis: MRI features and key findings for surgical decision. Insights Imaging 2025;16:131. https://doi.org/10.1186/s13244-025-02005-6. Moura Filho JP, Leão RV, Horvat N, Helito PVP, Amaral DT, Viana PCC, et al. What abdominal radiologists should know about extragenital endometriosis-associated neuropathy. Abdom Radiol (NY) 2020;45:1818–28. https://doi.org/10.1007/s00261-018-1864-x. Shats M, Bart Y, Burke YZ, Cohen SB, Zolti M, Zajicek M, et al. Endometrioma increases the risk of antibiotic treatment failure and surgical intervention in patients with pelvic inflammatory disease. Fertil Steril 2023;119:1008–15. https://doi.org/10.1016/j.fertnstert.2023.02.004. Onder O, Dilek I, Erdogan C, Toker Onder I, Arik E, Atasoy G, et al. Multimodality imaging findings of infected endometriomas: “T1 signal reversal” as a potential diagnostic sign? Radiol Case Rep 2023;18:2452–60. https://doi.org/10.1016/j.radcr.2023.04.019. Cornman-Homonoff J, Fenster TB, Schiffman MH. Percutaneous drainage of an infected endometrioma. Clin Imaging 2019;58:105–7. https://doi.org/10.1016/j.clinimag.2019.06.012. Brookmeyer C, Fishman EK, Sheth S. Emergent and unusual presentations of endometriosis: pearls and pitfalls. Emerg Radiol 2023;30:377–85. https://doi.org/10.1007/s10140-023-02128-7. Nezhat C, Vu M, Vang N, Ganjoo K, Karam A, Folkins A, et al. Endometriosis Malignant Transformation Review: Rhabdomyosarcoma Arising From an Endometrioma. JSLS 2019;23:e2019.00038. https://doi.org/10.4293/JSLS.2019.00038. Takeuchi M, Matsuzaki K, Uehara H, Nishitani H. Malignant Transformation of Pelvic Endometriosis: MR Imaging Findings and Pathologic Correlation. RadioGraphics 2006;26:407–17. https://doi.org/10.1148/rg.262055041. Robinson KA, Menias CO, Chen L, Schiappacasse G, Shaaban AM, Caserta MP, et al. Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol (NY) 2020;45:1762–75. https://doi.org/10.1007/s00261-019-01914-7. SAMPSON JA. ENDOMETRIAL CARCINOMA OF THE OVARY, ARISING IN ENDOMETRIAL TISSUE IN THAT ORGAN. Arch Surg 1925;10:1. https://doi.org/10.1001/archsurg.1925.01120100007001. SCOTT RB. Malignant changes in endometriosis. Obstetrics and Gynecology 1953;2:283–9. Chiaffarino F, Cipriani S, Ricci E, Esposito G, Parazzini F, Vercellini P. Histologic Subtypes in Endometriosis-Associated Ovarian Cancer and Ovarian Cancer Arising in Endometriosis: A Systematic Review and Meta-Analysis. Reprod Sci 2024;31:1642–50. https://doi.org/10.1007/s43032-024-01489-9. Ioannidou A, Sakellariou M, Sarli V, Panagopoulos P, Machairiotis N. New Evidence About Malignant Transformation of Endometriosis—A Systematic Review. J Clin Med 2025;14:2975. https://doi.org/10.3390/jcm14092975. Barnard ME, Farland L V., Yan B, Wang J, Trabert B, Doherty JA, et al. Endometriosis Typology and Ovarian Cancer Risk. JAMA 2024;332:482. https://doi.org/10.1001/jama.2024.9210. Zuber M, Shoaib M, Kumari S. Magnetic resonance imaging of endometriosis: a common but often hidden, missed, and misdiagnosed entity. Pol J Radiol 2022;87:448–61. https://doi.org/10.5114/pjr.2022.119032. Sakala MD, Jha P, Tong A, Taffel MT, Feldman MK. MR Imaging of Endometriosis of the Adnexa. Magn Reson Imaging Clin N Am 2023;31:121–35. https://doi.org/10.1016/j.mric.2022.06.006. Tsili AC, Argyropoulou MI, Koliopoulos G, Paraskevaidis E, Tsampoulas K. Malignant transformation of an endometriotic cyst: MDCT and MR findings. J Radiol Case Rep. 2011;5(1):9–17. https://doi.org/10.3941/jrcr.v5i1.435. Patel-Lippmann KK, Wasnik AP, Akin EA, Andreotti RF, Ascher SM, Brook OR, et al. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms: 2023 Update. J Am Coll Radiol 2024;21:S79–99. https://doi.org/10.1016/j.jacr.2024.02.017. Liu S, Peng M, Yu R, Jin C, Zhou S, Deng Y, et al. Predictive value of MR imaging IVIM and T2 mapping in malignant transformation of endometriosis. Medicine 2025;104:e46665. https://doi.org/10.1097/MD.0000000000046665. Miller GC, Sokolova A, Bettington ML, Rosty C, Brown IS. Colorectal endometriosis – a challenging, often overlooked cause of colorectal pathology: a clinicopathological review of 114 cases. Pathology 2024;56:795–803. https://doi.org/10.1016/j.pathol.2024.04.006. Alaert J, Lancelle M, Timmermans M, Tanos P, Nisolle M, Karampelas S. Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review. J Clin Med 2024;13:2282. https://doi.org/10.3390/jcm13082282. Charkhchi P, Butcher M, Macura KJ. Vanishing pelvic mass: Decidualized endometriosis during pregnancy. Radiol Case Rep 2024;19:2535–9. https://doi.org/10.1016/j.radcr.2024.03.018. Rozalli FI, Rahmat K, Fadzli F, Boylan C, Deb P. Decidualized ovarian endometrioma in a pregnant woman mimicking ovarian malignancy: Magnetic resonance imaging and ultrasonographic findings. Iran J Radiol 2015;12. https://doi.org/10.5812/iranjradiol.21260. Ambrosio M, Casadio P, Filipponi F, Borghese G, Youssef A, Seracchioli R. Decidualized endometrioma in a non-pregnant woman. Ultrasound Obstet Gynecol 2021;58:781–2. https://doi.org/10.1002/uog.23643. Fernandez CM, Levine EM, Sodini I, Pena M, Shuber H, Elliott S. Decidualized Endometrioma: Its Sonography and Optimal Clinical Management. J Diagn Med Sonogr 2022;38:171–4. https://doi.org/10.1177/87564793211058696. Yin M, Wang T, Li S, Zhang X, Yang J. Decidualized ovarian endometrioma mimicking malignancy in pregnancy: a case report and literature review. J Ovarian Res 2022;15. https://doi.org/10.1186/s13048-022-00966-6. Ando T, Kato H, Kawaguchi M, Furui T, Morishige K, Hyodo F, et al. MR findings for differentiating decidualized endometriomas from seromucinous borderline tumors of the ovary. Abdom Radiol (NY) 2020;45:1783–9. https://doi.org/10.1007/s00261-020-02412-x. Hirsch M, Dhillon-Smith R, Cutner AS, Yap M, Creighton SM. The Prevalence of Endometriosis in Adolescents with Pelvic Pain: A Systematic Review. J Pediatr Adolesc Gynecol 2020;33:623–30. https://doi.org/10.1016/j.jpag.2020.07.011. Martire FG, Lazzeri L, Conway F, Siciliano T, Pietropolli A, Piccione E, et al. Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis. Fertil Steril 2020;114:1049–57. https://doi.org/10.1016/j.fertnstert.2020.06.012. Oliveira IJ, Pinto PV, Bernardes J. Noninvasive Diagnosis of Endometriosis in Adolescents and Young Female Adults: A Systematic Review. J Pediatr Adolesc Gynecol. 2025;38(2):124–138 https://doi.org/10.1016/j.jpag.2024.07.005. Lampl BS, King CR, Attaran M, Feldman MK. Adolescent endometriosis: clinical insights and imaging considerations. Abdom Radiol (NY) 2025;50:4844–53. https://doi.org/10.1007/s00261-025-04870-7. de Sanctis V, Matalliotakis M, Soliman AT, Elsefdy H, Di Maio S, Fiscina B. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract Res Clin Obstet Gynaecol 2018;51:138–50. https://doi.org/10.1016/j.bpobgyn.2018.01.023. Khashchenko EP, Uvarova E V., Chuprynin VD, Pustynnikova MYu, Fatkhudinov TKh, Elchaninov A V., et al. Pelvic Pain, Mental Health and Quality of Life in Adolescents with Endometriosis after Surgery and Dienogest Treatment. J Clin Med 2023;12:2400. https://doi.org/10.3390/jcm12062400. Chatman DL. Pelvic peritoneal defects and endometriosis: Allen-Masters syndrome revisited. Fertil Steril 1981;36:751–6. https://doi.org/10.1016/S0015-0282(16)45921-2. Millischer A-E, Santulli P, Da Costa S, Bordonne C, Cazaubon E, Marcellin L, et al. Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan. Fertil Steril 2023;119:626–33. https://doi.org/10.1016/j.fertnstert.2022.12.039. Vercellini P, Salmeri N, Somigliana E, Piccini M, Caprara F, Viganò P, et al. Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis. Hum Reprod 2024;39:1460–70. https://doi.org/10.1093/humrep/deae086. Tellum T, Bracco B, De Braud L V., Knez J, Ashton-Barnett R, Amin T, et al. Reproductive outcome in 326 women with unicornuate uterus. Ultrasound Obstet Gynecol 2023;61:99–108. https://doi.org/10.1002/uog.26073. Pitot MA, Bookwalter CA, Dudiak KM. Müllerian duct anomalies coincident with endometriosis: a review. Abdom Radiol (NY) 2020;45:1723–40. https://doi.org/10.1007/s00261-020-02465-y. Kapczuk K, Zajączkowska W, Madziar K, Kędzia W. Endometriosis in Adolescents with Obstructive Anomalies of the Reproductive Tract. J Clin Med 2023;12:2007. https://doi.org/10.3390/jcm12052007. Chamié LP, VanBuren WM, Xiao L, Pires Franco IV, Feldman MK, Causa Andrieu P, et al. Postmenopausal Endometriosis: Clinical Insights and Imaging Considerations. Radiographics. 2024;44(12):e240046. doi: 10.1148/rg.240046. Erratum in: Radiographics. 2024;44(12):e249012. https://doi.org/10.1148/rg.249012. Cope AG, VanBuren WM, Sheedy SP. Endometriosis in the postmenopausal female: clinical presentation, imaging features, and management. Abdom Radiol (NY) 2020;45:1790–9. https://doi.org/10.1007/s00261-019-02309-4. Ghafoor S, Lakhman Y, Park KJ, Petkovska I. Polypoid endometriosis: a mimic of malignancy. Abdom Radiol (NY) 2020;45:1776–82. https://doi.org/10.1007/s00261-019-02143-8. Author information Authors and Affiliations Contributions All authors contributed substantially to the conception and design of this educational review. ASP led the conceptualization of the manuscript and defined its structure and scope. Literature search, selection of relevant references, and synthesis of evidence were performed by ASP, ECL, VM, SEG, IFB and AVC. Imaging contributions were provided by ASP, ECL, VM, SEG, CSC, BPB, and AVC. Imaging case selection, curation, and figure preparation were carried out by ASP and AVC. ASP, ECL, and AVC performed the final internal review prior to submission to all co-authors. All authors approved the final version of the manuscript. Corresponding author Ethics declarations Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Salgado-Parente, A., Canales Lachén, E., Murad, V. et al. Endometriosis: imaging spectrum of unusual locations and atypical presentations. Abdom Radiol (2026). https://doi.org/10.1007/s00261-026-05629-4 Received: Revised: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s00261-026-05629-4