title: Delayed diagnosis is associated with changes in the clinical and ultrasound features of subcutaneous endometriosis near cesarean section scars.
abstract: BACKGROUND
  The aim of the present study was to highlight the sonographic and clinical characteristics of large (≥30 mm in diameter) scar endometriomas near Pfannenstiel incisions, assuming that large size is a marker of delayed diagnosis.
  
  
  METHODS
  We compared clinical, ultrasound (US) and color Doppler findings in 13 patients (mean age 31.3 years) with 13 large scar endometriomas (L-SEs) (mean lesion diameter 41.8 mm; range 30-60 mm) and 17 women (mean age 30.7 years) with 19 small scar endometriomas (S-SEs) (mean lesion size 18.3 mm; range 7-26 mm).
  
  
  RESULTS
  Compared with the S-SE group, the L-SE group had a significantly longer mean interval between the last cesarean section and hospital admission (5.5 vs. 3.3 years; p < 0.01) and longer mean duration of symptoms before admission (43 vs. 17.4 months; p < 0.01). The L-SE group also had a significantly higher percentage of patients who had undergone at least one inconclusive diagnostic examination (Computed Tomography, Magnetic Resonance Imaging, fine needle biopsy, or laparoscopy) (39% vs. 0%; p < 0.05). As for US findings, L-SEs more frequently displayed cystic regions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05).
  
  
  CONCLUSIONS
  Delayed diagnosis of scar endometrioma reflected by a longer and more complex medical history results in larger than usual endometriomas with peculiar US findings, which are even more likely to be misinterpreted by physicians and radiologists.
authors: Diagnostic and Interventional Sonography Unit, Santa Maria della Pietà Hospital, Casoria (NA), Italy.
authors: G
authors: G
authors: Francica
authors: F
authors: F
authors: Scarano
keywords: Cesarean section; Color Doppler; Endometriosis; Ultrasound
references: J Obstet Gynaecol. 2004 Oct;24(7):804-8
references: 15763794
references: Gynecol Obstet Invest. 2007;63(2):107-13
references: 17028436
references: J Ultrasound Med. 2003 Oct;22(10):1041-7
references: 14606559
references: Eur Radiol. 2006 Feb;16(2):285-98
references: 16155722
references: J Ultrasound Med. 2007 Aug;26(8):993-1002
references: 17646361
references: N Engl J Med. 1993 Jun 17;328(24):1759-69
references: 8110213
references: Am Surg. 1999 Jan;65(1):36-9
references: 9915529
references: AJR Am J Roentgenol. 2006 Mar;186(3):616-20
references: 16498086
references: AJR Am J Roentgenol. 1993 Mar;160(3):549-50
references: 8430549
references: Br J Surg. 1995 Oct;82(10):1349-51
references: 7489161
references: AJR Am J Roentgenol. 1997 Sep;169(3):916-7
references: 9275932
references: J Am Coll Surg. 2000 Apr;190(4):404-7
references: 10757377
references: Dig Dis Sci. 2002 Feb;47(2):456-61
references: 11855568
references: Am J Surg. 2003 Jun;185(6):596-8
references: 12781893
references: Gynecol Endocrinol. 1993 Sep;7(3):207-21
references: 8291459
references: Clin Obstet Gynecol. 1966 Jun;9(2):373-83
references: 5330411
references: Am Surg. 2001 Oct;67(10):984-6
references: 11603558
references: Clin Radiol. 1994 Aug;49(8):578-9
references: 7955876
references: Radiographics. 2001 Jan-Feb;21(1):193-216; questionnaire 288-94
references: 11158655
references: J Clin Ultrasound. 2008 Feb;36(2):91-7
references: 18067126
references: Surg Gynecol Obstet. 1993 Sep;177(3):243-6
references: 8356497
references: Obstet Gynecol. 1979 Dec;54(6):753-5
references: 160025
references: Am Surg. 1994 Apr;60(4):259-61
references: 8129246
references: Radiology. 1999 Mar;210(3):739-45
references: 10207476
references: J Reprod Med. 2007 Jul;52(7):630-4
references: 17847762
references: J Comput Assist Tomogr. 1984 Dec;8(6):1213-4
references: 6238984
references: Am Surg. 1995 Nov;61(11):962-3
references: 7486427
references: Obstet Gynecol. 1980 Jul;56(1):81-4
references: 7383492