EndometeriomaPosted in General Ultrasound on June 30, 2010 by m.khodeer
Same pt, off-midline view. DDx?
Different patient, is this image consistent with the finding shown on the previous images? Confirmatory Study?
Correlative Imaging: Imaging Finding and Final Dx?
T1
T1 Fat Sat
T2
Answer: Endometrioma:
Left image: Longitudinal scan shows a relatively homogeneous lesion with increased through transmission and a fluid-fluid level.
Right image: Image from a different patient showed a large, multiloculated (complex) lesion surrounding the left ovary.
*Echogenicity of endometriomas varies from cystic to solid; they are the result of multiple episodes of bleeding; may be large (up to 20 cm!). *Simple Pelvic DDx for reproductive-age female: “PIE-D”. Pregnancy (ectopic); Infection / abscess, Endometrioma, Dermoid.
Given the wide differential of the US appearance, confirmation can be important if the diagnosis is not known.
T1
T1 Fat Sat
T2
  
T1 image shows a characteristic high signal lesion, similar to fat.
Lack of suppression on T1 Fat Sat. differentiates from a fatty lesion (e.g., dermoid)
T2 signal is characteristically low, from high iron concentration within the endometrioma.
Pelvic Differentials:
DDx for Sonographically Solid Pelvic Mass (female):
Features of ovarian masses suspicious malignancy:
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