Abdominal Radiology

, Volume 42, Issue 5, pp 1517–1523 | Cite as

Abdominal wall endometriosis: differentiation from other masses using CT features

  • Gail YarmishEmail author
  • Evis Sala
  • Debra A. Goldman
  • Yulia Lakhman
  • Robert A. Soslow
  • Hedvig Hricak
  • Ginger J. Gardner
  • H. Alberto Vargas



To assess the utility of morphologic and quantitative CT features in differentiating abdominal wall endometriosis (AWE) from other masses of the abdominal wall.


Retrospective IRB-approved study of 105 consecutive women from two institutions who underwent CT and biopsy/resection of abdominal wall masses. CTs were independently reviewed by two radiologists blinded to final histopathologic diagnoses. Associations between CT features and pathology were tested using Fisher’s Exact Test. Sensitivity, specificity, positive, and negative predictive values were calculated. P values were adjusted for multiple variable testing.


24.8% (26/105) of patients had histologically proven abdominal wall endometriosis. The other most common diagnoses included adenocarcinoma NOS (21%; 22/105), desmoid (14.3%; 15/105), and leiomyosarcoma (8.6%; 9/105). CT features significantly associated with endometriosis for both readers were location below the umbilicus (P = 0.0188), homogeneous density (P = 0.0188), and presence of linear infiltration irradiating peripherally from a central soft tissue nodule (i.e., “gorgon” sign) (P < 0.0001). The highest combined sensitivity (0.69, 95% CI: 0.48–0.86) and specificity (0.97, 95% CI: 0.91–1.00) for both readers occurred for patients having all three of these features present. Border type (P = 0.0199) was only significant for R2, peritoneal extension (P = 0.0188) was only significantly for R1, and the remainder of features were insignificant (P = 0.06–60). There was overlap in Hounsfield units on non-contrast CT (N = 26) between AWE (median: 45HU, range: 39–54) and other abdominal wall masses (median: 38.5HU, range: 15–58).


CT features are helpful in differentiating AWE from other abdominal wall soft tissue masses. Such differentiation may assist decisions regarding possible biopsy and treatment planning.


Endometriosis Abdominal wall CT 


Compliance with ethical standards


This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was granted by the IRB of both institutions.

Informed consent

IRB of both institutions waived the requirement for informed consent.


  1. 1.
    Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M (2008) Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg 196(2):207–212CrossRefGoogle Scholar
  2. 2.
    Granese R, Cucinella G, Barresi V, et al. (2009) Isolated endometriosis on the rectus abdominis muscle in women without a history of abdominal surgery: a rare and intriguing finding. J Minim Invasive Gynecol 16(6):798–801CrossRefGoogle Scholar
  3. 3.
    Matter M, Schneider N, McKee T (2003) Cystadenocarcinoma of the abdominal wall following caesarean section: case report and review of the literature. Gynecol Oncol 91(2):438–443CrossRefGoogle Scholar
  4. 4.
    Gidwaney R, Badler RL, Yam BL, et al. (2012) Endometriosis of abdominal and pelvic wall scars: multimodality imaging findings, pathologic correlation, and radiologic mimics. Radiographics 32(7):2031–2043CrossRefGoogle Scholar
  5. 5.
    Hensen JH, Van Breda Vriesman AC, Puvlaert J (2006) Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. AJR Am J Roentgenol 186:616–620CrossRefGoogle Scholar
  6. 6.
    Zhu Z, Al-Beiti MA, Tang L, Liu X, Lu X (2008) Clinical characteristic analysis of 32 patients with abdominal incision endometriosis. J Obstet Gynaecol 28:742–745CrossRefGoogle Scholar
  7. 7.
    Busard MP, Mijatovic V, van Kuijk C, Hompes PG, van Waesberghe JH (2010) Appearance of abdominal wall endometriosis on MR imaging. Eur Radiol 20:1267–1276CrossRefGoogle Scholar
  8. 8.
    Ahn SE, Park SJ, Moon SK, Lee DH, Lim JW (2016) Sonography of abdominal wall masses and masslike lesions: correlation with computed tomography and magnetic resonance imaging. J Ultrasound Med 35(1):189–208CrossRefGoogle Scholar
  9. 9.
    Francica G (2012) Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar. World J Radiol 4(4):135–140CrossRefGoogle Scholar
  10. 10.
    Savelli L, Manuzzi L, Di Donato N, et al. (2012) Endometriosis of the abdominal wall: ultrasonographic and Doppler characteristics. Ultrasound Obstet Gynecol 39:336–340CrossRefGoogle Scholar
  11. 11.
    Coley BD, Casola G (1993) Incisional endometrioma involving the rectus abdominis muscle and subcutaneous tissues: cT appearance. AJR Am J Roentgenol 160(3):549–550CrossRefGoogle Scholar
  12. 12.
    Giudice LC, Swiersz LM, Burney RO (2010) Endometriosis. In: Jameson JL, De Groot LJ (eds) Endocrinology, 6th edn. New York: Elsevier, pp 2356–2370Google Scholar
  13. 13.
    Aytac HO, Aytac PC, Parlakgumus HA (2015) Scar endometriosis is a gynecological complication that general surgeons have to deal with. Clin Exp Obstet Gynecol 42(3):292–294PubMedGoogle Scholar
  14. 14.
    Cornelius F, Petipierre F, Lasserre E, et al. (2014) Percutaneous cryoablation of symptomatic abdominal scar endometrioma: initial reports. Cardiovasc Interv Radiol 37(6):1575CrossRefGoogle Scholar
  15. 15.
    Carrafiello G, Fontana F, Pellegrino C, et al. (2009) Radiofrequency ablation of abdominal wall endometrioma. Cardiovasc Interv Radiol 32(6):1300CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Gail Yarmish
    • 1
    Email author
  • Evis Sala
    • 2
  • Debra A. Goldman
    • 3
  • Yulia Lakhman
    • 2
  • Robert A. Soslow
    • 4
  • Hedvig Hricak
    • 2
  • Ginger J. Gardner
    • 5
  • H. Alberto Vargas
    • 2
  1. 1.Staten Island University HospitalNew YorkUSA
  2. 2.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of PathologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  5. 5.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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