Endometriomas in the region of a scar from Cesarean section: Sonographic appearance and clinical presentation vary with the size of the lesion

Purpose. To describe the sonographic (US) appearances of endometriomas developed in the vicinity of a scar from Cesarean section and compare sonographic and clinical characteristics of large (≥3 cm) scar endometriomas (LSEs) with small scar endometriomas (SSEs). Method. Twenty‐eight consecutive women (mean age, 31 years; range, 20–42) with 31 scar endometriomas (mean diameter, 2.7 cm; range, 0.7–6 cm) were examined by US, including color Doppler imaging prior to surgery. Clinical and US findings in women with LSE were compared with those of women with SSE. Results. Twelve patients had 12 LSEs with a mean longest diameter of 4.1 cm (range, 3–6 cm); in 1 case, a large nodule was associated with a small lesion. Sixteen women had 18 SSEs with a mean lesion size of 1.8 cm (range, 0.7–2.6 cm). The mean time interval between the last Cesarean section and hospital admission was longer in patients with LSE (66 versus 40 months; p < 0.01) as was the mean duration of symptoms before admission (43 versus 17 months; p < 0.01); in addition, 41.6% of patients with LSE had undergone previous inconclusive diagnostic examinations (CT, MRI, fine needle aspiration, or laparoscopy) compared with 0% in patients with SSE (p < 0.05). LSEs more frequently showed cystic portions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05) than SSEs did. Conclusion. LSEs were associated with a delay in diagnosis and some US findings that could result in further diagnostic difficulties. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009.