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.

One comment

  1. Marisol Reynoso says:

    Hi my name is Marisol and I had a complete hysterectomy on November 2015; however, as of today I’m still having very similar endometriosis pain that I had before the hysterectomy in the right groin area and right side of the abdomen as well as my right sciatic “this last one is been new to me since October 2016” well I was send to a gastroenterologist and she had me done abdomen ultra sound “which I really don’t think she even looked at, since she didn’t even talked about until I asked and she just said everything is fine!” An endonoscopy and colonoscopy just to tell me that I have some “bacteria” that can be the reason of my abdomen pain? Really ? That cost me $750 and by the way I still have the pain so my obgy said that all I can do is just to manage my pain unles I want to go under surgery again to find where is the endometriosis!
    My point is that those that suffer from endometriosis like me and for years, most of the times we don’t get diagnosed correctly and we don’t get taken serious. Is a shame how with the level of technology that we have no one hasn’t been able to progress in this matter and we just continue to be mutilated in the name of endometriosis. I’m 41 years old, no kids and took me 25 years to diagnose with endometriosis. After reading this post I feel more anxious. I guess we have to be rushed to the ER in order to be looked deeper into our pain … my pain lavel is so high sometimes that makes me wonder if I would end up lossing my right leg one time, is sad and tired to be living with such enigmatic condition. At times it takes your live away… I really wish an ultrasound could see our endometriosis

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