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Abdominal Wall Endometriosis: Clinical Presentation and Imaging Features with Emphasis on Sonography

¹ Department of Radiology, MCH Westeinde Hospital, The Hague, Lijnbaan 32, PO Box 432, NL-2501 CK, The Netherlands.
² Department of Radiology, Rijnland Hospital, Leiderdorp, NL-2350 CC, The Netherlands.

OBJECTIVE. The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MR appearance.

MATERIALS AND METHODS. A computerized search of our institution's database over a 5-year period was performed, yielding 12 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography including power Doppler examination. Additional CT was performed in one patient and MRI in four. Pathologic material was preoperatively obtained by sonographically guided puncture in six patients. The clinical data were analyzed, and the imaging studies were reviewed by two radiologists working in consensus.

RESULTS. All patients had a history of at least one prior cesarean section. All presented with focal pain near the surgical scar, which was cyclic in three patients. Nine patients presented with a palpable mass near the scar. Sonography detected 11 lesions within the abdominal wall, with a mean diameter of 25 mm. All lesions were hypoechoic, vascular, and solid, with some cystic changes in one. The calculated frequency of abdominal wall endometriosis is approximately 0.8% of all women who had a cesarean delivery.

CONCLUSION. Abdominal wall endometriosis frequently presents with noncyclic symptoms. Imaging findings of a solid mass near a cesarean section scar strongly suggest its diagnosis.

Keywords: abdominal wall • cesarean delivery • endometriosis • soft-tissue neoplasms • women's imaging

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