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Endometriomas

Case contributed by Dr Alexandra Stanislavsky

Presentation

Young female presents with right iliac fossa pain. LMP 4 weeks ago.

Patient Data

Age: 25 years
Gender: Female
Ultrasound

There were four large pelvic masses, each with homogeneous ground-glass echotexture, with no internal vascularity or septations.  Scattered small high density, nonvascular foci around the periphery - a characteristic feature.  One of the masses, to the right of midline and most anterior, had lower echotexture and contained a small amount of echogenic, mobile material.

Ovaries were identified separately to these masses but were difficult to see.  There was only a small amount of fluid in the pouch of Douglas.

Case Discussion

This case demonstrates the typical ultrasound appearance of endometriomas.  At surgery these were confirmed to be huge chocolate cysts. 

It was hypothesized that a recent hemorrhage into the relatively hypoechoic endometrioma which had a fluid level may have been the cause of the patient's pain.

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