Presentation
Nodule of endometriosis suspected in pouch of Douglas at time of a prior benign surgery.
Patient Data
ANTERIOR COMPARTMENT: normal.
MIDDLE COMPARTMENT:
Uterus: Anteverted anteflexed 88 mm long with normal morphology. Endometrium 8 mm thick and regular. No myometrial lesion. Posterior cervical 13 mm unilocular T1 bright T2 dark Nabothian cyst.
Ovaries: normal. Right ovary 4 follicles. Left ovary 3 follicles and 21 mm follicular cyst.
Fallopian tubes: normal.
POSTERIOR COMPARTMENT:
At 113 mm from anal opening posterior to the torus there is a mid rectal linear 20 x 4 mm T2 decreased bowel endometriosis without bowel distortion or focal T1 hyperintensity, connecting by a thin T2 dark fibrotic band isthmus to a posterior vagina/left uterosacral ligament 20 mm nodule. This obliterates the PoD.
Rectovaginal septum: normal.
Case Discussion
This MRI shows subtle linear mid rectal bowel endometriosis.
Perception is aided by looking for butterfly shapes - wings connecting rectum and vaginal vault or uterine torus or cervix.
Emphasis on comparison to prior transvaginal ultrasound, especially subspecialist gynecologist sonologist scans specifically for endometriosis, on reporting pelvic MRI to avoid reporting false negative studies for subtle but real findings (this PoD endometriosis was seen at surgery prior to imaging, prompting the imaging to map disease).
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