Department of Radiology, Winthrop-University Hospital, 259 First St, Mineola, NY 11501, USA.
Radiographics. 2012 Nov-Dec;32(7):2031-43. doi: 10.1148/rg.327125024.
Implantation of an endometriotic lesion within a pelvic or abdominal wall scar is an uncommon but well-described condition that may be the underlying cause of acute or chronic recurrent abdominal or pelvic pain, especially after cesarean section. Radiologists may not consider scar endometriosis when it is encountered at cross-sectional imaging. Cesarean section scars are the most common site of extraovarian or extrauterine endometriosis. The condition also has been identified in other uterine surgery-related scars and in the skin, subcutaneous tissues, and abdominal and pelvic wall musculature adjacent to these scars. The most plausible cause of scar endometriosis is implantation of endometrial stem cells at the surgical site at the time of uterine surgery. Patients with scar endometriosis may be asymptomatic or present with cyclical pain corresponding to the menstrual cycle. Cross-sectional imaging findings vary from the nonspecific to those suggestive of the diagnosis when combined with clinical history. In particular, the presence of blood products in an anterior abdominal wall mass at magnetic resonance (MR) imaging with no other explanation is strongly suggestive of scar endometriosis. Ultrasonography, computed tomography, and MR imaging may be used to depict an endometriotic lesion, exclude endometriosis, or provide evidence for an alternative diagnosis.
在骨盆或腹部壁瘢痕内植入子宫内膜病变是一种不常见但已有充分描述的病症，可能是导致急性或慢性复发性腹痛或盆腔痛的根本原因，尤其是在剖宫产术后。放射科医生在遇到横断面成像时可能不会考虑瘢痕内异症。剖宫产瘢痕是卵巢外或子宫外子宫内膜异位症最常见的部位。这种病症也已在其他与子宫手术相关的瘢痕以及这些瘢痕附近的皮肤、皮下组织以及腹部和骨盆壁肌肉组织中被发现。瘢痕内异症最合理的原因是在子宫手术时，子宫内膜干细胞在手术部位的植入。有瘢痕内异症的患者可能无症状，或表现为与月经周期相对应的周期性疼痛。当结合临床病史时，横断面成像结果从非特异性到提示诊断的结果各不相同。特别是在磁共振成像（MR）检查中，在前腹壁肿块中存在血液产物而无其他解释时，强烈提示为瘢痕内异症。超声、计算机断层扫描和 MR 成像可用于显示子宫内膜病变、排除子宫内膜异位症，或为其他诊断提供证据。
