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Objective: The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis., Materials and Methods: A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13). All patients underwent transvaginal and abdominal ultrasound including power Doppler examination. Two radiologists working in consensus analyzed the clinical data and reviewed the imaging studies., Results: All 25 patients presented with lower abdominal pain that was cyclic in six patients. Eleven patients were unintended childless. Rectal discomfort was mentioned by 17 patients, two of whom also reported rectal blood loss. At physical examination, eight patients had a palpable mass in the posterior cul-de-sac. Transvaginal ultrasound detected one or more hypoechoic masses in the posterior cul-de-sac in all 25 patients. All masses were solid, noncompressible, and localized on the serosal surface of the rectosigmoid with sparing of mucosa and submucosa. The lesions had a rounded or ovoid shape and a mean sagittal diameter of 37 mm with vascularity. The masses had a spiculated or tethering contour in 19 patients. Abdominal ultrasound detected thick-walled adnexal cysts in 11 patients, hydronephrosis in eight, and involvement of the ileocecal region in five., Conclusion: Patients with endometriosis of the posterior cul-de-sac frequently present with atypical noncyclic symptoms. The transvaginal ultrasound features characteristic of posterior cul-de-sac endometriosis are a solid, often spiculated, noncompressible mass near the posterior cul-de-sac that is localized at the serosal surface of the rectosigmoid, spares the mucosa and submucosa, and is vascular.

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.