Transvaginal sonographic appearance of endometriomata: spectrum of findings

The spectrum of transvaginal sonographic findings was evaluated in 37 surgically proved endometriomas. Sonographic features assessed included lesion size, acoustic enhancement, wall thickness, wall contour, presence of a fluid-fluid level, and presence of internal echoes. A very characteristic finding seen in 31 (82%) cases is the presence of a homogeneous hypoechoic "carpet" of low-level echoes. This may be present diffusely or in one or several loculations of a multiloculated cystic mass. We consider this finding characteristic of an endometrioma, although not pathognomonic, as on occasion we have encountered other pathologic conditions that have the same appearance.