Case Review: Ultrasound of Endometrioma

In this radiology lecture, we review the ultrasound appearance of endometrioma through three unique cases, including an MRI example.
Key teaching points include:
1) Endometriosis = Ectopic endometrial glands and stroma outside of the uterine cavity. Includes endometriomas, extraovarian implants and adhesions.
2) Endometriomas = Endometriotic cysts within ovary.
3) Endometriosis is seen in about 10% of women of reproductive age.
4) Presentation: Pelvic pain, dysmenorrhea, dyspareunia, infertility.
5) Ultrasound: Diffuse, homogeneous low-level echoes (most specific feature) yielding a ground glass appearance. May have posterior acoustic enhancement.
6) Endometriomas may have peripheral punctate echogenic foci. These foci have no internal vascular flow but can see twinkle artifact.
7) Vascular flow may be present in endometrioma septations.
8) Endometrioma vs. hemorrhagic cyst: Hemorrhagic cysts are acute, usually solitary and unilocular, whereas endometriomas are chronic, sometimes multiple and multilocular.
9) Endometriomas can rarely (1%) undergo malignant transformation into endometrioid carcinoma or clear cell carcinoma.
10) MR is the most specific imaging modality for diagnosis of endometrioma = Specificity 98%.*
11) Homogeneous, T1 “light bulb” bright, T2 dark = “T2 shading.”
12) Surgical treatment: Depends on disease severity from laparoscopic cyst aspiration/cystectomy to hysterectomy/oophorectomy.
13) Medical management may be attempted: Oral contraceptives, GnRH agonists.
*Reference: Togashi K, Nishimura K, Kimura I, et al. Endometrial cysts: Diagnosis with MR imaging. Radiology. 1991;180:73-78.
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[@GynaecologyUltrasound]

Great demo of ovarian endometriomas, thank you
I have a couple of (I hope constructive) comments - In case 2, the endometrium is early luteal phase and the haemorrhagic cyst is a h’gic corpus luteum, which might evolve into an endometrioma.
The peripheral irregular echogenic material lining the endometrioma cyst wall is probably clot. The clot retracts toward the periphery, giving this concave appearance. Areas of malignant transformation tend to be convex/polypoidal.
And where there are ovarian endometriomas, there is almost always Deep Endometriosis….it is very valuable information for the surgeon to know this pre-op.
Lovely videos, thank you :)

[@Radquarters]

Outstanding points, thank you, especially regarding the peripheral endometrioma clot vs. the less common malignant transformation!

[@candyland8903]

I was just diagnosed with an endometrioma on my left ovary and my Dr said she just wants to keep observing it. Went into the ER in Feb for severe pelvic pain. After running a CT scan and ultrasound, they found the cyst on the left and right side, and free fluid on the right side. Since then my Dr had me come ever two months for a coup follow up ultrasounds. Since then the cyst on the left she said is for sure an endometrioma a little less the 5cm and the right side seems fine. I read online that if u have an endometrioma that you likely have stage 3 endo. When I discussed this with my Dr, she dismissed my concerns saying this endometrioma is small and I likely won't have any issues if I'm not in pain anymore. The pain in Feb was due to one rupturing I believe because of the collection of free fluid, but my Dr won't say for sure what it was. My blood work came back all abnormal showing major signs of infection which is why they did the CT scan and ultrasound. They were worried I was septic cause of how much pain I was in and huddled over and couldn't walk. I was vomiting. My keytones were super high but so was my glucose. My lab work was just all bad. But basically the er Dr just said to follow up with my gyno. And ever since, my gyno seems to be dismissing me cuz I'm no longer in pain most of the time. I am wondering if what I read is accurate, and the sign of an endometrioma means it's stage 3 and likely spread to other areas of caused issues in surrounding organs? Cause I have major IBS symptoms as well as bladder issues. I've even had to have a catheter put in before due to not being able to urinate even tho I had a full bladder

[@aurora_12349]

My usg states resolving haemmorhagic cyst? Endometriotic cyst. What does that mean. Please explain. Do I have endometriosis?

[@GynaecologyUltrasound]

@@aurora_12349 Hi - generally speaking a haemorrhagic cyst means the sonographer has seen some blood in the ovary. That can happen during a normal ovulation. A repeat scan (if this is necessary) would show that the cyst will resolve in a few months....If the cyst doesn't resolve, it could be an endometrioma - a collection of blood in the ovary - and that is caused by endometriosis. 'The sonographer was obviously uncertain which of the 2 it is, they may well arrange for a rescan after a number of weeks to decide which it is.

[@caiyu538]

Thumb up your tutorials although not familiar with ultrasound.

[@khalidsalehabrahman8446]

Thanks for knowledge on it

[@Radquarters]

Sure thing

[@MohmadfahimAfzali]

What is the difference between endometrioma and dermoid cyst on ultrasound ?? Please send me the answer

[@Radquarters]

Here is my lecture on dermoid cyst: ruclips.net/video/AM07wRqt5EI/видео.htmlsi=xHO4-XDuSKJnKXFV Hope that helps!

[@mohsenahmed4535]

Thank you so much

[@Radquarters]

You're welcome!

[@radheyshyamyadav5486]

👍👍

[@Radquarters]

Thank you!