Utility of Ultrasound in the Evaluation of Adolescents Suspected of Endometriosis

Transvaginal sonography (TVS) has been proposed as the first-line imaging technique in evaluating patients with pain and suspicion for endometriosis because it allows extensive exploration of the pelvis. In young patients, TVS showed great advantages over TAUS in the ability to place a high-frequency transducer next to the region of interest and to the possible endometriotic lesions in the pelvis. A transrectal approach with TVS probe may be considered in adolescents with an intact hymen. Small “typical” endometrioma is a unilocular cyst with homogeneous low-level echogenicity (ground glass echogenicity) of the cyst fluid that could be seen in teenagers. In adolescent patients with chronic pelvic pain, it is also important to look for sonographic signs of adhesions and TVS “soft markers” (i.e., site-specific tenderness, reduced ovarian mobility). The 2D real-time dynamic TVS examination of adhesions and pouch of Douglas (POD) obliteration, using the sliding sign technique, seems to be useful in the identification of adhesion and small posterior deep endometriotic lesions. Utilizing TVS, an accurate assessment of the vagina, particularly the areas of the posterior and lateral vaginal fornices, the retrocervical area with torus uterinum, the uterosacral ligaments, and the rectovaginal septum, should be performed. The slightly filled bladder permits to better evaluate the structure of the walls and the presence of endometriotic nodules, which appears as hypoechoic linear or spherical lesions bulging toward the lumen, involving the serosa, muscularis, or (sub)mucosa of the bladder. Deep endometriotic nodes of the rectum appear as hypoechoic lesions, linear or nodular retroperitoneal thickening with irregular borders, penetrating into the intestinal wall distorting its normal structure. It seems very important to evaluate in adolescent patients small lesion below the peritoneum between the vagina and rectum that could not be seen by the purely diagnostic laparoscopy which is often be performed in these patients when imaging is negative. 2D TVS typical myometrial features and 3D evaluation of the junctional zone seem very important to diagnose adenomyosis. Increased JZ thickness or small adenomyotic cysts of the inner or outer myometrium can be detected in adolescent patients with dysmenorrhea or excessive menstrual bleeding. In adolescent patients, an accurate TVS can provide a lot of information, and being able to detect retroperitoneal endometriotic lesions and adenomyosis is probably better than a purely diagnostic laparoscopy that evaluates only superficial lesion. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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Conflict of Interest All the authors report no conflict of interest. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2020 Springer Nature Switzerland AG About this chapter Cite this chapter Exacoustos, C., Martire, F.G., Lazzeri, L., Zupi, E. (2020). Utility of Ultrasound in the Evaluation of Adolescents Suspected of Endometriosis. In: Nezhat, C.H. (eds) Endometriosis in Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-030-52984-0_17 Download citation DOI: https://doi.org/10.1007/978-3-030-52984-0_17 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-52983-3 Online ISBN: 978-3-030-52984-0 eBook Packages: MedicineMedicine (R0)