Both ovaries appear enlarged and in close proximity, located in the rectouterine space, containing multiple irregular cystic lesions of variable sizes, most of which demonstrate a hyperintense signal on T1 fat-sat, corresponding to a heterogeneously hypointense signal on T2-weighted images "Shading sign (endometrioma)". Findings are consistent with multiple bilateral ovarian endometriomas.
Tortuous dilated fallopian tubes, measuring around 1.5 - 1.8 cm in maximal diameter, with T1 hyperintense internal contents, best seen on T1 FS, suggestive of tubal blood, which is more pronounced on the left side, in keeping with bilateral hematosalpinx.
A small amount of T1 hyperintense fluid is seen within the endometrial cavity, suggestive of hematometrium.
Large intramural leiomyoma arising from the left side of the uterine body, resulting in moderate architectural distortion of the endometrial cavity, exhibiting considerable mass effect on the adjacent pelvic structures.
Tortuous dilated parametrial venous structures with associated dilatation of both ovarian veins, suggestive of pelvic congestion.