OC19.05: Ultrasound features and pattern recognition in abdominal wall endometriosis

Abdominal wall endometriosis is often misinterpreted on ultrasound, despite the frequent catamenial symptoms. Imaging can provide valuable clues to the diagnosis, especially when clinical features are not evident. The recent use of linear ultrasound probes with better visualisation prompted us to elucidate the sonographic features of this entity. This is a retrospective multicentre study of ultrasound features of pathologically confirmed abdominal wall endometriosis using high-frequency linear probes. The images were reviewed by two operators and consensus reached. The study comprised 30 premenopausal women. Two of the three umbilical lesions constituted spontaneous endometriosis while the remainder presented in surgical scars. The endometrial implants were typically heterogeneous (97%), predominantly hypoechoic (87%) and poorly vascularised (70%). All exhibited spiculated margins. Small cystic areas were seen in 80% and 73% manifested acoustic shadowing. A characteristic pattern of heterogeneous (fibrotic) core with peripheral cysts (hemorrhage) and spiculated (infiltrative) margins was observed in 63% (figure 1). This could be indicative of the natural disease progression observed in endometriosis elsewhere: infiltration, hemorrhage and fibrosis. Spiculated margins, heterogeneity and acoustic shadowing in a hypoechoic abdominal wall lesion are suggestive of endometriosis. Ultrasound examination with particular attention to the aforementioned distinctive pattern may enhance diagnostic accuracy, obviate the need for further imaging, and result in appropriate counselling and surgical planning. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.