Table 2 Keys to evoke the diagnosis of complicated endometriosis
From: Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis
Clinical finding | Cause | Warning context | Modality | Imaging features | Differential diagnosis |
|---|---|---|---|---|---|
Acute pelvic pain | PID | ART | US/MRI | / | / |
| Â | Endometrioma surinfection | ART | US/MRI | Loss of hypersignal T1, loss of shading sign, very low ADC value | Tubo-ovarian abscess |
| Â | Endometrioma rupture | / | US/CT | Ascite, hyperintense on T1, distorted endometrioma | Ruptured corpus luteal cyst |
Right lower quadrant pain | Endometriotic appendicitis | / | US/CT | Soft tissue mass within appendix/Mucocele | Appendicitis/ Appendix tumor |
Renal colic | Ureteral obstruction by endometriosis | / | US/CT | Extrinsic compression of the distal ureter by a retractile mass | Retroperitoneal fibrosis/urothelial lesion |
Parietal pain | Abdominal wall endometriosis | Cesarean delivery/pelvic surgery | US/MRI | Enhancing wall mass with irregular margin, and cystic components in hypersignal T1/T2 | Desmoid tumor |
Bowel obstruction | LBO | / | CT/MRI | Extrinsic soft-tissue mass compressing the sigmoid colon, asymmetric thickening of the colonic wall | Colon cancer |
| Â | SBO | / | CT | Non-specific | / |
| Â | Intussusception | / | CT | Non-specific | / |
Peritoneal syndrome | Spontaneous hemoperitoneum | Pregnancy | US/CT/MRI | Ascite, hyperintense on T1 (± distorted endometrioma) | / |
| Â | Inflammatory peritoneal | / | CT | Non-specific | / |
| Â | Bowel perforation | / | CT | Non-specific | / |