This case demonstrates a few manifestations of endometriosis, in the form of multiple ovarian endometriomas and hematosalpinx. 

When endometriosis affects the cul-de-sac along with bilateral ovarian involvement, deep pelvic adhesions may result in pulling of both oavries towards the midline, often seen posteriorly in the rectouterine pouch, giving rise to the Kissing ovaries sign. 

Around one third of women with endometriosis show tubal disease. The serosal lining of the tubes is commonly affected, resulting in tubal adhesions with secondary luminal obstruction. Less than half of the tubes affected may demonstrate high intraluminal signal on T1FS (Hematosalpinges), when endometrial implants are involving the serosa. Differentials for dilated fluid-filled fallopian tubes include simple hydrosalpinx or pyosalpinx as a result of pelvic inflammatory disease.