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Review
. 2020 Oct 20;10(10):848.
doi: 10.3390/diagnostics10100848.

Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge

Marco Scioscia  1 , Bruna A Virgilio  1 , Antonio Simone Laganà  2 , Tommaso Bernardini  1 , Nicola Fattizzi  1 , Manuela Neri  3   4 , Stefano Guerriero  3   4
Affiliations
Review

Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge

Marco Scioscia et al. Diagnostics (Basel). .

Abstract

Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions' appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment.

Keywords: abdominal wall; adenomyosis; bladder; bowel; endometriosis; ovary; rectum; ureter; vagina.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A pyramid chart that represents the distribution of ultrasound scans for endometriosis according to complexity. Although differential diagnosis must be considered in each exam, the number of cases where it makes a difference is relatively small, although it is fundamental.
Figure 2
Figure 2
Bifocal endometriosis of the bladder (arrow). The two lesions present different characteristics as the one on the right-hand side presents a typical solid aspect while the left one is a cystic endometriosis location. Abbreviations: B, bladder; C, cervix; U, uterus.
Figure 3
Figure 3
Cystic endometriosis (arrow) of the retroperitoneum in two patients on medical therapy with previous pelvic surgery for endometriosis. (A) shows an endometriosis cyst of the rectovaginal septum and (B) shows a cyst of the mesometrium. Abbreviations: U, uterus; R, rectum; O, Ovary.
Figure 4
Figure 4
Appendix dislocated downward and attached to the ovary that may mimic mesorectal endometriosis. (A,B) show the clean and the labelled image. Abbreviations: A, appendix; O, Ovary; BPL, broad posterior ligament; C, caecum; MR, mesorectum; RSJ, rectosigmoid junction.
Figure 5
Figure 5
A typical endometriosis nodule (arrow) of the bladder (A); figure (B) shows a flat nodule of endometriosis (arrow) with a subserosal myoma that distorts the bladder dome; a flat endometriosis nodule (arrow) of the bladder that can be seen at 3D ultrasound only when cut (C) while the internal surface of the bladder appears regular (D); figure (E) shows a thick bladder wall due to cystocele and figure (F) in case of recurrent cystitis. Abbreviations: U, uterus; B, bladder; M, myoma.
See this image and copyright information in PMC

References

    1. Zondervan K.T., Becker C.M., Missmer S.A. Endometriosis. N. Engl. J. Med. 2020;382:1244–1256. doi: 10.1056/NEJMra1810764. - DOI - PubMed
    1. Nnoaham K.E., Hummelshoj L., Webster P., d’Hooghe T., de Cicco Nardone F., de Cicco Nardone C., Jenkinson C., Kennedy S.H., Zondervan K.T. World Endometriosis Research Foundation Global Study of Women’s Health consortium Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertil. Steril. 2011;96:366373.e8. doi: 10.1016/j.fertnstert.2011.05.090. - DOI - PubMed
    1. Burney R.O., Giudice L.C. Pathogenesis and pathophysiology of endometriosis. Fertil. Steril. 2012;98:511–519. doi: 10.1016/j.fertnstert.2012.06.029. - DOI - PMC - PubMed
    1. Dunselman G.A.J., Vermeulen N., Becker C., Calhaz-Jorge C., D’Hooghe T., De Bie B., Heikinheimo O., Horne A.W., Kiesel L., Nap A., et al. ESHRE guideline: Management of women with endometriosis. Hum. Reprod. 2014;29:400–412. doi: 10.1093/humrep/det457. - DOI - PubMed
    1. Schliep K., Chen Z., Stanford J., Xie Y., Mumford S., Hammoud A., Boiman Johnstone E., Dorais J., Varner M., Buck Louis G., et al. Endometriosis diagnosis and staging by operating surgeon and expert review using multiple diagnostic tools: An inter-rater agreement study. BJOG Int. J. Obstet. Gynecol. 2017;124:220–229. doi: 10.1111/1471-0528.13711. - DOI - PMC - PubMed

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