"Kissing ovaries": a sonographic sign of moderate to severe endometriosis

Abstract

Objective: To evaluate whether the presence of kissing ovaries at ultrasound is a marker for endometriosis and whether it correlates with the severity of the disease.

Design: Prospective observational study.

Setting: Gynecologic departments of two university hospitals.

Patient(s): A total of 722 consecutive premenopausal women who had laparoscopic surgery for an adnexal mass or suspected pelvic endometriosis.

Intervention(s): Preoperative ultrasound evaluation and laparoscopic surgery.

Main outcome measure(s): Diagnostic and predictive value of ultrasound identification of kissing ovaries in the detection of endometriosis.

Result(s): Kissing ovaries were diagnosed at ultrasound and confirmed laparoscopically in 32 patients. Of these, 27 had moderate to severe endometriosis and five others had benign adnexal masses. Bowel (18.5% vs. 2.5%) and fallopian tube (92.6% vs. 33%) endometriosis were significantly more frequent in patients with kissing ovaries than in patients without kissing ovaries. In infertile patients (n = 145), kissing ovaries were associated with a higher proportion of women with fallopian tube obstruction (80% vs. 8.6%). Considering patients with moderate to severe endometriosis (n = 189), the median (range) revised American Fertility Society score (74 [32-148] vs. 35 [16-146]) and the operative time (115 minutes [65-245 minutes] vs. 50 [15-180 minutes]) were significantly higher in patients with than in those without kissing ovaries.

Conclusion(s): The detection of kissing ovaries at ultrasound is strongly associated with the presence of endometriosis and is a marker of the most severe form of this disease.