Presentation
Pelvic pain increased during menstruation.
Patient Data
Two lesions of intermediate to low signal intensity are detected on T2WI, implicating the anterior wall of the upper third rectum with the classic "Mushroom cap sign of endometriosis". Another endometriotic lesion is observed on the left posterolateral wall of the upper third vagina. There is no diffusion restriction visible on the lesions, but they do show post-contrast enhancement.
The uterus is bulky and shows multiple variable-sized fibroids the largest located on the anterior wall. The junctional zone is relatively thickened with hyperintense myometrial foci suggesting adenomyosis.
Case Discussion
This case obviously demonstrates the classic mushroom cap sign which represents endometriosis implants on the surface of the rectosigmoid colon.
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