• Dr Peter Chew

Recently, I was diagnosed with endometriosis which was confirmed by laparoscopy (fig 1)...

Recently, I was diagnosed with endometriosis which was confirmed by laparoscopy (fig 1). But I was perplexed why during my annual check-up two months ago, the ultrasound scan of my pelvis reported that there were ” no abnormalities seen in the uterus and ovaries”. Could the ultrasound examination miss the diagnosis?

A. From the picture you sent (fig 1), it looks like you have endometriosis with implants on the lining of the pelvic wall (peritoneum)

Endometriosis exists in 3 forms:

1. Patches or lesions on the peritoneum (the condition you have):

These are implants on the surface of various pelvic organs. They are of various shapes, sizes and colours. These different colours usually reflect different stages of the disease.   The patches tend to be pink or red in early stages and turn brown or black when the disease is more chronic. Many women have a mixture of both types of patches.

2. Ovarian cyst or “chocolate” cyst (Also known colloquially as “blood” cyst) (fig2):

A cyst is a sac filled with fluid. When endometriosis grows in the ovary, it fills the ovary with dark brown stale fluid, resembling that of chocolate and hence the name. The cyst can grow to several centimetres in size. They are usually formed in the later stages of endometriosis.

3. Deep Infiltrating Endometriosis:

This is an uncommon form of the disease in which a solid hard  tumour is present. It usually penetrates into the bowel, bladder and/or vagina for 5 mm or more and cause very severe backache and pain.

Of the modalities used in diagnosing endometriosis,

·         Laparoscopy continues to be the gold standard for the diagnosis of endometriotic implants and ovarian cysts.

·         Ultrasound is poor at diagnosing peritoneal implants but is useful in the detection and evaluation of ovarian cysts.

·         MRI is increasingly being used, especially in the evaluation of deep infiltrating disease.

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