Abdominal Wall Endometriomas Near Cesarean Delivery Scars

PURPOSE: To describe the sonographic and color Doppler features of endometriomas of the abdominal wall arising near cesarean delivery scars. METHODS: Twelve women (mean age, 31 years; range, 22-42 years) underwent sonographic and color Doppler examination of the abdominal wall with high-frequency probes for the presence of painful nodules near cesarean delivery scars, cyclic or continuous lower abdominal pain, or both. RESULTS: All patients had undergone at least 1 cesarean delivery before admission (mean, 4.1 years; range, 2-12 years). A typical clinical presentation (ie, mass and cyclic pain and swelling during menses) was recorded in 6 cases. Sonography disclosed all subcutaneous nodules (mean size, 28.1 mm; range, 7-50 mm). Common sonographic features included (1) a hypoechoic inhomogeneous echo texture with internal scattered hyperechoic echoes; (2) irregular margins, often spiculated, infiltrating the adjacent tissues; and (3) a hyperechoic ring of variable width and continuity. At color Doppler examination, a single vascular pedicle entering the mass at the periphery was shown in 7 cases. Abundant intralesional vascularization was shown in 3 cases with diameters of greater than 3 cm, whereas no vascular sign could be detected in 2 lesions smaller than 15 mm. All patients underwent wide surgical excision, and pathologic examination disclosed endometrial tissue in all of them. No relapses were recorded at clinical and sonographic follow-up (4-23 months). CONCLUSIONS: Sonographic and color Doppler findings, when properly combined with clinical data, may substantially contribute to the correct preoperative diagnosis of abdominal wall endometriomas.