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Pattern 2 – Filmy Adhesions & Candle Wax Phenomenon

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Okay, so now we've seen a

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nice case of kissing ovaries.

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So the other two patterns in superficial

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peritoneal disease include filmy

0:09

adhesions and candle wax phenomenon.

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So I'll just talk a little bit about those.

0:14

So filmy adhesions are the presence of

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web-like structures or wispy structures

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floating around in free fluid.

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And they really just are adhesions

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that have developed as a reaction

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to peritoneal endometriosis.

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And because they're quite thin,

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in this example, you can see this

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adhesion here and maybe a little bit of

0:35

an adhesion here, they're quite thin.

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So they're challenging to see on MRI.

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So this is typically a finding that

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is noted on ultrasound, particularly.

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If you're scanning the patient, it

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probably wouldn't necessarily get captured

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on still images, but if you're scanning

0:52

the patient, you can certainly look for

0:54

these adhesions, and that's a good sign

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of superficial peritoneal endometriosis.

1:00

And then the other feature in pattern two is the

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presence of what's called candle wax phenomenon.

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So it's a really nice description of what's

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going on, and that is the presence of

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multiloculated cystic structures that surround

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an endometrioma due to repeated hemorrhage.

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So as the bleeding happens over

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time within the endometrioma.

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We have some repeated areas of bleeding, and

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then healing, bleeding, and then healing,

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and that tends to accumulate around the ovary

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itself, and that's what these areas are.

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So this is a sign that we can sometimes see on

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MRI, and if you look for that, and if you're

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aware of it, you probably will find it, but

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it's also quite often seen on sonography.

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So once you have an endometrioma,

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we don't just stop there.

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We want to look outside the ovary.

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We want to look for the

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wispy or filmy adhesions.

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And then we want to look at

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the position of the ovaries.

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Are they midline or are they in

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their normal lateral position?

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So those are the typical

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manifestations of pattern two.

Report

Faculty

Zahra Kassam, MD, FRCPC

Associate Professor of Medical Imaging, Division Head of Body Imaging

Western University

Tags

Uterus

Ultrasound

Pelvic Wall and Floor

Ovaries

Non-infectious Inflammatory

Neoplastic

MRI

Idiopathic

Gynecologic (GYN)

Body

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