Endometriomas can have a diverse appearance with a wide spectrum of sonographic features. Patel et al identified sonographic findings that can help recognize a subset of endometriomas. The authors are from the Mayo Clinic Scottsdale.
Features strongly favoring endometrioma - cystic structure with:
(1) diffuse low level internal echoes
(2) absence of neoplastic features (including wall nodularities)
(3) presence of hyperechoic wall OR multilocularity
Wall nodularities can be seen in endometriomas and in ovarian neoplasms. The presence of nodules identifies a lesion that may require additional imaging studies or surgical removal.
Features suggesting recent hemorrhage:
(1) fibrinous strands (fine interdigitating lines with fishnet appearance)
(2) retracting clots (marginal clumped echoes with concave margins)
The authors found that wall thickness did not help determine if a mass was or was not an endometrioma.
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