📄 SCRS

LSCS
Endometriosis

Endometriosis ultrasound case study

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LSCS Pathology

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USG

LSCS endometriosis ultrasound case study

CASE–1

Clinical History

A 32-year-old female presented with a painful swelling in the anterior lower abdominal wall over the previous lower segment cesarean section (LSCS) scar. The pain was cyclical, increasing during menstruation. The patient was referred for ultrasound evaluation to assess the palpable scar lesion.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined irregular heterogeneously hypoechoic solid lesion within the anterior abdominal wall involving the subcutaneous tissue and rectus sheath at the site of the previous LSCS scar. ternal scattered echogenic foci and mild posterior acoustic attenuation are noted. Color Doppler demonstrates mild to moderate internal vascularity. Mild surrounding fibrotic changes are present. No liquefaction, abscess, or fascial defect is identified. No evidence of incisional hernia is seen.

Ultrasound of the anterior abdominal wall. A heterogeneously hypoechoic vascular soft tissue lesion is demonstrated within the previous LSCS scar, consistent with scar endometriosis.

Report Line

A well-defined heterogeneously hypoechoic soft tissue lesion is noted within the anterior abdominal wall at the site of the previous LSCS scar, measuring approximately 35 × 26 mm. The lesion demonstrates mild to moderate internal vascularity on Color Doppler with surrounding fibrotic changes. No cystic degeneration, abscess, or incisional hernia is identified. Sonographic findings are highly suggestive of abdominal wall (LSCS scar) endometriosis.

Impression

Features are consistent with abdominal wall endometriosis involving the previous LSCS scar. No sonographic evidence of abscess formation or associated incisional hernia.

Recommendation

Correlation with the history of cyclical pain and previous cesarean section is recommended. Surgical consultation for complete excision is advised. Histopathological examination following excision is recommended for definitive diagnosis. MRI may be considered for preoperative assessment if deep fascial or muscular involvement is suspected.

Key Learning Points

• Scar endometriosis is a rare complication following cesarean section or other gynecological surgeries.
• The typical clinical presentation is a painful palpable mass at the surgical scar with cyclical worsening during menstruation.
• Ultrasound usually demonstrates a heterogeneously hypoechoic solid lesion with internal vascularity.
• Differential diagnoses include suture granuloma, desmoid tumor, hematoma, abscess, incisional hernia, and soft tissue neoplasm.
• MRI is useful for evaluating the extent of disease before surgery.
• Complete surgical excision with clear margins is the treatment of choice and minimizes recurrence.
• Histopathological examination remains the gold standard for definitive diagnosis.