Presentation
Preoperative endometriosis mapping. A RANZCOG DDU TVUS for endometriosis has identified pelvic endometriosis requiring a subspecialist surgeon's opinion. She has requested an MRI to stage.
Patient Data
ANTERIOR COMPARTMENT:
Urinary bladder: Adequately distended. Left lateral bladder base 16 mm T2 dark intramural mass with T2 and T1 bright foci consistent with deep endometriosis. This tethers the sigmoid and left uterine horn.
Vesicovaginal septum: Normal.
Right vesicouterine pouch is normal.
No hydroureter.
MIDDLE COMPARTMENT:
Uterus: Variant uterine anatomy with two horns, two cervices cranially, fused to a single
cervix caudally. Single vagina. Endometrium 1 mm thin and regular bilaterally. Left horn
fundal myometrial junctional zone thickening without T2 or T1 bright foci, suggesting focal
adenomyosis. Left horn anterior serosa, 21 x 6 mm, T2 dark deep endometriotic plaque tethers
the sigmoid anteriorly and the urinary bladder medially. No contralateral lesion.
Ovaries show normal follicular activity and pelvic locations. No endometriomata.
No haemato or hydrosalpinges.
POSTERIOR COMPARTMENT:
Rectosigmoid colon: Normal with superficial tethering at the left urinary bladder/left horn only.
No bowel DIE identified. Cinematic image demonstrates reduced bowel mobility and fixed
uterus.
Pouch of Douglas: On the left obliterated, patent on right.
Left uterosacral ligament thickening with tethered sigmoid.
OTHER:
Left groin/inguinal ligament 21 x 14 mm, T2 decreased mass with surrounding tissue distortion,
T2/T1 bright foci consistent with anterior abdominal wall endometriosis.
Ultrasound images are courtesy of Dr Anjana Thottungal, Perth Obstetrics and Gynecological Ultrasound.
Case Discussion
Anterior, middle and posterior compartment endometriosis mainly involving the left horn of a
variant uterus and the urinary bladder. There is also a left groin abdominal wall nodule.