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Uterine scar endometriosis

Uterine scar endometriosis ultrasound case study

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Uterine Pathology

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Uterine scar endometriosis ultrasound case study

CASE–1

Clinical History

A 33-year-old female with a previous lower segment cesarean section (LSCS) presented with progressive dysmenorrhea, chronic pelvic pain, and intermittent abnormal uterine bleeding. She was referred for pelvic ultrasound to evaluate a suspected uterine scar lesion.

Ultrasound Findings

Ultrasound examination demonstrates a well-defined heterogeneous hypoechoic lesion involving the anterior lower uterine segment at the site of the previous cesarean section scar. The lesion extends into the adjacent myometrium with indistinct margins. Multiple tiny internal echogenic foci are noted. Color Doppler demonstrates mild to moderate internal vascularity. The remainder of the myometrium is unremarkable without focal fibroids. The endometrium measures 9.5 mm in thickness and appears regular. No pelvic abscess or free fluid is identified.

TVS pelvic ultrasound. A heterogeneous hypoechoic lesion is demonstrated within the previous cesarean section scar in the lower uterine segment, compatible with uterine scar endometriosis.

Report Line

A well-defined heterogeneous hypoechoic lesion measuring approximately 25 × 18 × 16 mm is identified within the anterior lower uterine segment at the site of the previous cesarean section scar. The lesion extends into the adjacent myometrium and demonstrates mild internal vascularity on Color Doppler with a few internal echogenic foci. A focal communication with the anterior endometrial lining through the cesarean scar defect is noted. No significant surrounding fluid collection is identified. Sonographic findings are highly suggestive of uterine cesarean scar endometriosis.

Impression

Sonographic features are consistent with uterine scar endometriosis involving the previous cesarean section scar. No evidence of pelvic abscess or associated adnexal inflammatory collection.

Recommendation

Correlation with the patient's history of previous cesarean section and cyclical pelvic pain is recommended. MRI pelvis may be performed to assess the depth of myometrial involvement and exclude associated adenomyosis if clinically indicated. Gynecological consultation is advised. Surgical excision with histopathological examination remains the definitive treatment.

Key Learning Points

• Uterine scar endometriosis is a rare form of cesarean scar endometriosis involving the myometrium of the lower uterine segment.
• Patients typically present with cyclical pelvic pain, dysmenorrhea, and abnormal uterine bleeding.
• Ultrasound commonly demonstrates a heterogeneous hypoechoic lesion within the cesarean scar with internal vascularity.
• The differential diagnosis includes cesarean scar defect (isthmocele), scar hematoma, adenomyosis, fibroid, and cesarean scar pregnancy.
• MRI provides superior assessment of lesion extent and myometrial infiltration.
• Complete surgical excision is the treatment of choice.
• Histopathological examination confirms the diagnosis.