“Kissing ovaries”: A sonographic sign of moderate to severe endometriosis

To evaluate whether the presence of kissing ovaries at ultrasound is a marker for endometriosis and whether it correlates with the severity of the disease. Prospective observational study. Gynecologic departments of two university hospitals. A total of 722 consecutive premenopausal women who had laparoscopic surgery for an adnexal mass or suspected pelvic endometriosis. Preoperative ultrasound evaluation and laparoscopic surgery. Diagnostic and predictive value of ultrasound identification of kissing ovaries in the detection of endometriosis. Kissing ovaries were diagnosed at ultrasound and confirmed laparoscopically in 32 patients. Of these, 27 had moderate to severe endometriosis and five others had benign adnexal masses. Bowel (18.5% vs. 2.5%) and fallopian tube (92.6% vs. 33%) endometriosis were significantly more frequent in patients with kissing ovaries than in patients without kissing ovaries. In infertile patients (n = 145), kissing ovaries were associated with a higher proportion of women with fallopian tube obstruction (80% vs. 8.6%). Considering patients with moderate to severe endometriosis (n = 189), the median (range) revised American Fertility Society score (74 [32–148] vs. 35 [16–146]) and the operative time (115 minutes [65–245 minutes] vs. 50 [15–180 minutes]) were significantly higher in patients with than in those without kissing ovaries. The detection of kissing ovaries at ultrasound is strongly associated with the presence of endometriosis and is a marker of the most severe form of this disease.