Ultrasound evaluation of deep infiltrating endometriosis

Introduction. Endometriosis with different stages of seve­ri­ty affects approximately 5% of women. It can in­volve the ovaries, the pelvic peritoneum, the pouch of Douglas (POD), the rectum, the rectosigmoid junction, the rectovaginal sep­tum (RVS), the uterosacral ligaments (USL), the vagina and the bladder. The ultrasound evaluation is the firsthand method to detect ovarian endometriosis, but recently it has proven its value in the diagnosis of deep infiltrating en­do­me­trio­sis (DIE). Materials and method. We have eva­luated the medical database and international guides re­gar­ding ultrasound examination of DIE. Results. Recent data prove that the purpose of ultrasound examination of a woman suspected of endometriosis is to explain the main symp­toms, to identify the lesions and to evaluate the grade of severity before choosing the appropiate conservatory or sur­gi­cal means of therapy. Using transvaginal ultrasound as the first means of diagnosis, the examiner must first eva­lu­ate the uterus and adnexa. Ovarian endometriomas are frequently associated with other endometriosis-specific le­sions such as adhesions and DIE. The second step is to look for “soft markers” and to test the mobility of the ovaries. The presence of these signs increases the chance that DIE and adhesions are to be found. By applying pressure between the uterus and ovaries, one can test whether the ova­ries are fixed to the uterosacral ligaments, medially or laterally to adjacent structures. The third step is the eva­lua­tion of the pouch of Douglass using the sliding sign. The fourth and final step is to search for DIE nodules in the anterior and posterior compartments of the pelvis. Con­clusions. Transvaginal ultrasound is the firsthand me­thod of evaluating patients with ovarian endometriosis and DIE. The prediction of severe forms of DIE, as well as the obliteration of the pouch of Douglas are essential in planning a multidisciplinary surgical approach.