In scar endometriosis, undoubtedly MRI is the preferred modality of imaging since tiny lesions can be identified, hemorrhagic foci depiction, presurgical anatomic mapping and also the depth of invasion can be accurately seen. The rare possibility of transformation into endometrioid adenocarcinoma can also be identified.

Similarly, radiology reporting should include the above points.

The closest differential would be a desmoid tumor - clinical consideration is key - it can be associated with a recent history of trauma, anticoagulation therapy or Gardner syndrome and other fibromatoses. Also no cyclical pain.

Special thanks: Dr HT Gururaj.