Ultrasound Exam Helped Doctors Diagnose Rare Case of Extrapelvic Endometriosis

Ultrasound Exam Helped Doctors Diagnose Rare Case of Extrapelvic Endometriosis

Ultrasound examination can be an extremely useful tool for the diagnosis of rarer cases of endometriosis outside of the pelvic region, a study says.

The study, “Thrombosis Of Iliac Vessels, A Rare Complication Of Endometriosis: Case Report And Review Of Literature,” was published in the Journal of Advanced Research.

Endometriosis is an estrogen-dependent inflammatory process that usually affects organs localized in the pelvic region, such as the ovaries, pelvic peritoneum, utero-sacral ligaments, Douglas pouch, vagina, rectum and bladder. Other regions also can be affected, but their extrapelvic localization, much rarer than other types of endometriosis, makes diagnosis more difficult.

Researchers reported the case of a 38-year-old Caucasian woman who was admitted to the hospital due to acute right groin pain. She had regular and painless menstruation cycles and showed no symptoms that doctors could attribute to her cycle.

An ultrasound exam detected a solid mass in the right region of the abdomen, near the iliac vessels. Doctors then performed several examinations to discard a diagnosis of several possible types of cancer. They also performed an ultrasound-guided biopsy of the mass, which allowed them to confirm the presence of endometriosis in the patient’s abdomen muscle.

The size and position of the mass blocked blood flow in the affected region, which could trigger a deep vein thrombosis (blockade of blood flow) in the area. The patient was immediately treated with anticoagulant therapy and given an elastic stocking, but after three days, she developed deep vein thrombosis in the iliac vein.

Doctors then applied a transcatheter thrombolysis to re-establish blood flow in the affected vein, and operated on the patient to remove the mass. The patient refused hormonal therapy to preserve her fertility. Six months after the treatment, the patient had no pain and had improved her clinical condition and quality of life, according to the study.

According to the authors, few studies have reported endometriosis affecting the abdominal wall, especially cases of endometriosis involving the iliac vessel, and no study has described a case associated with thrombosis of the iliac vein.

“The presented patient had a very rare localization of endometriosis and an uncommon complication, the thrombosis of iliac vessel,” they wrote. “This rare clinical and radiological presentation of extrapelvic endometriosis has not been yet reported in the literature and made diagnosis difficult.”

They believe that, for cases of extrapelvic endometriosis, the use of ultrasound examination can play an important role in the accurate diagnosis of patients because symptoms can vary and are not exactly related to disease severity.

“[Ultrasound] had an essential role in detecting and localizing endometriosis, and providing definitive histological diagnosis through ultrasound-guided biopsy,” the authors concluded.