Interactive Transcript
0:01
Okay, so let's look at another case
0:03
of endometriosis and specifically
0:05
we're going to look at rectosigmoid
0:07
involvement in this case, but I wanted
0:09
to show you a few more things as well.
0:11
So remember our approach to
0:13
endometriosis and research pattern.
0:16
So in the last case, we looked first
0:18
at the position of the ovaries.
0:20
So here we've got an axial T2
0:22
weighted sequence, and we can see the
0:24
left ovary that's got a cyst in it.
0:28
And as we scroll down, we can see something
0:30
that looks like a right ovary here, but
0:33
note the position of that right ovary.
0:36
So it's definitely not lateral or adjacent
0:40
to the external or common iliac vessels,
0:43
but it's definitely more inferior to
0:45
its normal location and closer to the midline.
0:47
It's being drawn in or dragged
0:49
in by some other process here.
0:51
So that position of that ovary is not normal.
0:54
All right.
0:54
So we've noted that abnormal position
0:57
of the right ovary, and then the left
1:00
ovary obviously looks enlarged, and we've
1:02
got some T2 shading here, which on T1
1:06
corresponds to some high signal here.
1:10
And this is a nice case
1:11
as well to show you that.
1:13
candle wax phenomenon that we talked about.
1:15
So look at the outside of this left ovary.
1:18
Look at these little cystic structures
1:20
that are next to the ovary, and some
1:23
of them have some high T1 signal.
1:25
So you would be able to see this on ultrasounds.
1:28
We've got an endometrioma with some little
1:30
cysts around it that are hemorrhagic.
1:32
And that's a really nice example
1:34
of the candle phenomenon.
1:37
Okay.
1:38
And then if we look at the torus uterinus.
1:41
So remember, that's along the posterior wall of
1:45
the uterus and kind of anterior to the rectum.
1:48
We've got this ill-defined area of
1:51
pretty low T2 signal, and there's
1:54
an area of kind of high T2 signal.
1:57
And if we look at the T1-weighted
1:58
images in the same area, we've got
2:00
these little dots of high T1 signal.
2:02
So this is definitely a
2:04
manifestation of endometriosis.
2:06
So this is an implant, an area of fibrosis,
2:09
scarring, and probably repeated bleeding.
2:11
So if you're a breast imager, you would
2:14
call this architectural distortion.
2:16
So this is kind of a similar phenomenon
2:18
where the scarring is causing pulling or
2:21
retraction of the adjacent structures.
2:24
You can see the rectal wall here
2:25
is kind of tethered anteriorly.
2:27
So it's pulling in all the
2:29
adjacent structures, the right
2:30
ovary as well as being pulled in.
2:32
And then if we look at the sagittal images, this
2:35
is kind of nice because when we see the torus
2:39
veneratus thickening, this is the area where
2:40
the abnormality would be on the sagittal images.
2:42
And then look what's happened
2:44
to the anterior rectal wall.
2:45
We've got this low T2 signal,
2:48
submucosal lesion here.
2:51
And.
2:52
Hopefully you can imagine that it
2:54
looks like the cap of a mushroom.
2:56
That's what the mushroom cap sign looks like.
2:58
So if you were to do a barium enema in this
3:00
patient, you would see opacification of
3:03
the rectum, and then you'd see this smooth
3:06
semicircular filling defect because of this
3:08
rectosigmoid involvement by endometriosis.
3:11
So, again along the posterior
3:13
margin of the uterus, notice how
3:15
we've got a linear configuration.
3:18
It's not nice and smooth.
3:19
We've got some thickening, a triangular
3:21
shape there, and that corresponds
3:23
to thickening of the torus uteritis.
3:25
So this patient actually has several
3:27
manifestations of endometriosis
3:29
that we've talked about already.
3:31
And then she's also got an IUD here that
3:34
we can see nicely with some susceptibility
3:36
artifact on the gradient echo images.
© 2024 MRI Online. All Rights Reserved.