Presentation
Lower abdominal pain. Tenderness over the previous section cesarian scar.
Patient Data
There is a nodule noted in the left lower abdominal wall with following details:
- It is ill defined with spiculated borders. It appears heterogeneously hyperintense on T1 and T2 images, suggestive of subacute hemorrhage foci.
- It is seen in the deep subcutaneous plane along the course of previous lower segment cesarean section scar.
- Infiltration into the underlying rectus abdominal muscle. However no breach of the posterior border of the muscle or extension into the peritoneal cavity.
- Mild edema noted in the surrounding subcutaneous plane.
Case Discussion
In scar endometriosis, undoubtedly MRI is the preferred modality of imaging since tiny lesions can be identified, hemorrhagic foci depiction, presurgical anatomic mapping and also the depth of invasion can be accurately seen. The rare possibility of transformation into endometrioid adenocarcinoma can also be identified.
Similarly, radiology reporting should include the above points.
The closest differential would be a desmoid tumor - clinical consideration is key - it can be associated with a recent history of trauma, anticoagulation therapy or Gardner syndrome and other fibromatoses. Also no cyclical pain.
Special thanks: Dr HT Gururaj.
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