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Sllavko K. Kallfa

Radiological SignsShnja Radiologjike)

Prmbledhje Artikujsh nga

Radiopaedia.org

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EndometriomaDr Yuranga Weerakkody and Dr Jeremy Jones et al.

An endometrioma (also known as a chocolate cyst or endeometriotic cyst ) is a localised formof endometriosis (usually within the ovary).

Epidemiology

It affects women of reproductive age.

Pathology

It contains dark degenerated blood products following repeated cyclical haemorrhage. The cystsmay be up to 20 cm in size although they are usually smaller (2-5cm)

Location

Typical locations include

ovaries : ~ 75% anterior / posterior cul-de-sac : ~ 70 % posterior broad ligament : ~ 50% uterosacral ligaments : ~ 35% uterus : ~ 10 % colon : ~ 5%

Radiographic features

Plain film

Not usually helpful in diagnosis. ~ 10% of endometriomas can calcify.

Ultrasound

In the typical situation there is acoustic enhancement with diffuse homogenous low-level internalechoes as a result of the haemorrhagic debris. This appearance occurs in 95% of cases and isconsidered the classic finding on ultrasound examination. Features of multi-locularity and hyper-echoic wall foci may be present. Anechoic cysts may occur, but they are rare.

MRI

Signal characteristics vary according to the age of any complicating haemorrhage 6.

T1 - typically, lesions appear hyper-intense while acute haemorrhage occasionallyappears hypo-intense

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T2 -o typically hypo-intense owing to the presence of deoxyhaemoglobin and

methaemoglobino old haemorrhage occasionally appears hyper-intense.

A shading sign3

may be seen and is very suggestive of an endometrioma.

Treatment and prognosis

Although endometrioma is a usually a benign entity, there is an approximately 1% rate ofmalignant transformation 4. It is seen mostly in women > 40 years after several years of latency,with endometriomas larger than 9cm 4-5. Malignant transformation is uncommon in masses