Endometrioma: analysis and sonographic classification of 51 documented cases

We analyzed 51 proven cases of endometrioma and characterized the sonographic patterns as purely cystic, cystic with few septations or minimal debris, complex combinations of cystic and solid elements, and largely solid. In this series, 30% were purely cystic, 62% showed various degrees of complexity with septation or debris, and 8% appeared essentially solid. The broad spectrum of patterns is in keeping with the evolutionary process of endometriomas, which follow essentially the same transitions from homogeneous gelatinous (cystic) through partially resolved (liquified) complex and ultimately returning to nearly purely cystic, as do hematomas. The average diameter of endometriotic masses was 6.1 cm (range, 2.0 to 20.0 cm), and the average age of the patients at diagnosis was 31.3 years (range, 15 to 45 years). The diversity of sonographic appearance, the span of essentially all the child-bearing years, and the presence of endometriomas without a history of infertility or dysmenorrhea (and even after hysterectomy) keep this entity a constant differential diagnostic consideration in sonographically identified pelvic masses. We believe this to be the largest documented series of sonographically identified endometriomas in the literature.