Presentation
Recurrent attacks of lower abdominal pain and tenderness. History of previous Cesarean sections.
Patient Data
There is an upper anterior uterine wall defect through which the endometrium is seen migrating to the lower anterior abdominal wall muscles causing infiltration and heterogeneous mass formation of the rectus abdominus muscles.
The lesion displays heterogeneous signal intensity on different pulse sequences with areas of hemorrhage and intense post-contrast enhancement.
Small amount of fluid is seen at the posterior Douglas pouch exhibiting increased signal on T2 and T1 weighted images denoting blood products.
There is a left ovarian small simple cyst.
L3-L4 and L4-L5 degenerative disc bulges are noted.
A deep ill-defined heterogeneous soft issue lesion is seen at the lower anterior abdominal wall, inseparable from the uterine cesarean section scar.
Case Discussion
The MRI features together with the history of repeated attacks of pain are keeping with deep lower anterior abdominal wall endometriosis.
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