What is your diagnosis?

What is your diagnosis: A woman with a history of cesarean section and chronic cyclic abdominal pain in her history showed these ultrasound findings in the abdominal wall.

Answer

Abdominal wall endometriosis

Abdominal wall scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women (1, 2). Any scar lesion that is involved in response to menstrual cycles should be considered as endometriosis, thus requiring wide surgical resection (1–3). The late onset of symptoms after surgery is the usual cause of misdiagnosis. Futhermore, malignant degeneration of extra pelvic endometriosis is described in the literature (3, 4).

The presented case has a 3×2 cm mass in the abdominal wall as shown with 3D multiplanar view in Figure 1 and with 2D view in Figure 2. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. The definitive diagnosis was established by histopathological studies.

Figure 1.

3D multiplanar imaging of abdominal wall mass

Figure 2.

2D imaging of abdominal wall mass