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Endometriosis - hourglass shaped lesions

Case contributed by: Dr Natalie Yang

From the case: Endometriosis - hourglass shaped lesions

Modality: MRI

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Hourglass lesion T2

Lesion 1 lies to the right of the cervix and contains layering debris. Lesion 2 lies posterior to the cervix, containing scattered foci of high T1 signal (best seen on T1FS), with associated rectal wall thickening and loss of fat planes suspicious for rectal involvement.

Case Discussion:

These lesions are typically larger than the rectovaginal septal or retroforniceal lesions (>3cm), and occur when a posterior forniceal lesion extends cranially toward the anterior rectal wall (commonly associated with rectal muscularis infiltration) but remain sub-peritoneal in location.

FINDINGS

Lesion 1 lies to the right of the cervix and contains layering debris.

Lesion 2 lies posterior to the cervix, containing scattered foci of high T1 signal (best seen on T1FS), with associated rectal wall thickening and loss of fat planes suspicious for rectal involvement.