Abdominal wall endometriosis: comparative imaging on power Doppler ultrasound and MRI

MR imaging of endometriosis: Spectrum of disease

Endometriosis is a common gynecological disorder defined by the presence of endometrial tissue outside the uterus. It is the most common cause of chronic pelvic pain and typically affects the ovaries, uterine ligaments, peritoneum, tubes, rectovaginal septum and bladder. It may, however, be found at various extrapelvic sites, including the perineum, liver, pancreas, lung or even the central nervous system, and in such cases, diagnosis may be quite challenging. Even though definitive diagnosis requires laparoscopy, preoperative identification of endometriosis is important not only to differentiate it from other diseases with similar clinical presentations but also, for accurate presurgical mapping, since complete removal of all endometriotic foci is critical for the effective treatment of the patient's symptoms. Ultrasound is performed initially, but magnetic resonance imaging (MRI) is increasingly being used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when surgery is planned, as it provides better contrast resolution and a larger field of view compared to ultrasound. In this article, we will discuss distinctive MRI appearances of endometriotic foci and we will review common and uncommon locations of endometriosis within the body, in an attempt to familiarize radiologists with its wide spectrum of manifestations.

Umbilical Endometriosis

Endometriosis is a common clinical disorder in which endometrial tissue is found outside the uterus. Although it is most commonly confined to the pelvis, it can present extra-pelvic. This case highlights one of the unusual locations of extra-pelvic endometriosis, the umbilical area, and the importance of including it in a differential diagnosis of any umbilical mass. When found at the umbilicus, sonographers should consider examining the pelvis for endometriomata and the abdomen and pelvis for any underlying malignancies.