Endometriomas and peritoneal inclusion cysts

Case contributed by Mostafa Mohamed
Diagnosis certain

Presentation

Pelvic pain with history of previous caesarean section and laproscopic intervention

Patient Data

Age: 25 years
Gender: Female
This study is a stack
Sagittal
T2
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Axial
T1
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Axial
T2
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Axial
STIR
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Axial T1
fat sat
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Coronal
T1
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Coronal
T2
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Coronal
STIR
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Axial
T1 C+
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Coronal
T1 C+
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Info
  • left adnexal lobulated lesion is seen, eliciting a high T1 signal with a low T2 signal (shading sign). It shows no signal drop in the Fat Sat images (left adnexal endometrioma)

  • right adnexal lesion elicits a fluid signal of high T2/STIR and low T1 signal.

  • a well-defined, loculated lesion is seen along the medial aspect of both rectus abdominis muscles with haemorrhagic nature (scar endometriomas). A similar lesion is observed at the deep subcutaneous aspect along the anterolateral aspect of the pelvis, abutting the right rectus abdominis muscle at the pelvic region

  • large left pelvic cystic lesion elicits a fluid-like signal. A smaller similar lesion is seen at the right deep pelvis (peritoneal inclusion cysts)

Case Discussion

  • the presence of a left adnexal endometrioma in a patient who has had a prior Caesarian section should prompt a search for scar endometrioma

  • peritoneal inclusion cyst is another complication of previous intervention

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