Presentation
The patient complains of lower abdominal intermittent attacks of pain. On examination, there is a plable swelling in close relation to the C-section scar.
Patient Data
A relatively well-defined lesion is seen at the inferior aspect of the right rectus abdominis muscle. It measures about 3 x 2 x 2 cm. 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. There is a rim of fluid seen anterior and posterior to the lesion. The lesion shows faint post-contrast enhancement.
Predominately hypoechoic solid lesion showing small cystic area and vascularity by color-flow imaging.
Case Discussion
Endometriosis of the abdominal wall or C-section scar usually presents with a swelling associated with cyclic pain. Ultrasound is usually the first modality for the evaluation, showing a lesion that is usually in close relation to C-section scar with cystic areas and vascularity. MRI is a more specific imaging modality that helps in locating other sites of endometriosis.
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