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Abdominal wall endometriosis

Case contributed by Dr Bahman Rasuli

Presentation

Left lower abdominal wall mass sensation associated with severe pain and tenderness during menstruation.

Patient Data

Age: 30 years
Gender: Female
MRI

A relatively well-defined heterogeneous enhancing lesion measures about 15x25x30 mm at the inferior aspect of the left rectus abdominis muscle

It displays heterogeneous signal intensity on T1WI and T2WI with hyperintense areas on both T1 and T2 fat-sat images suggestive of blood products. Smaller cystic changes are also seen. 

Case Discussion

Endometriosis is a common, chronic gynecological condition defined as the presence of functional endometrial glands and stroma-like lesions outside the uterus. It manifests in three ways; superficial (peritoneal) disease, ovarian disease, and deep infiltrating endometriosis, which is the most complex and surgically challenging form. Desmoid tumors, sarcoma, metastasis, and non-neoplastic causes such as hematoma, suture granuloma, abscess, and hernia are in the differential diagnosis. However, abdominal wall endometriosis in patients with an abdominal wall mass and classical history of cyclic pain should be considered as a first differential diagnosis.

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