Singh Anuradha, Das Chandan J, Das Bimal K, Gupta A K
Department of Radiology, AIIMS, New Delhi, India.
Department of Microbiology, AIIMS, New Delhi, India.
Indian J Radiol Imaging. 2017 Jul-Sep;27(3):314-317. doi: 10.4103/ijri.IJRI_86_16.
Extrapelvic endometriosis (EPE) is a rare entity which may potentially occur at any site. Symptomatic EPE is now increasingly being managed laparoscopically. Imaging is imperative in diagnosis as well as extent delineation prior to surgery. In addition to increasing the success rate of diagnostic laparoscopy, prior knowledge of EPE at certain sites may modify the standard surgical technique. We present here an unusual case of chronic pain in the right shoulder in a 26-year-old female caused by subdiaphragmatic endometriosis (SDE). It was noticed on conventional magnetic resonance imaging (MRI) sequences; however, due to the lack of the characteristic signal intensity, imaging findings were noncontributory. Diffusion-weighted imaging (DWI) facilitated its characterization and precisely mapped the extent of involvement. SDE should be suspected in young females presenting with cyclical shoulder pain. Due to nonspecific clinical features, it may remain undiagnosed. MRI is the imaging modality of choice in evaluation of EPE. Including DWI sequence in the MR protocol increases the diagnostic precision besides delineating the extent of involvement noninvasively.
盆腔外子宫内膜异位症（EPE）是一种罕见的病症，可能发生于任何部位。有症状的EPE目前越来越多地通过腹腔镜进行治疗。在手术前，影像学检查对于诊断以及明确病变范围至关重要。除了提高诊断性腹腔镜检查的成功率外，了解某些部位的EPE情况可能会改变标准手术技术。我们在此介绍一例26岁女性因膈下子宫内膜异位症（SDE）导致右肩慢性疼痛的罕见病例。在传统磁共振成像（MRI）序列上发现了病变；然而，由于缺乏特征性信号强度，影像学表现并无诊断价值。扩散加权成像（DWI）有助于对其进行特征性描述并精确确定受累范围。对于出现周期性肩部疼痛的年轻女性，应怀疑SDE。由于临床特征不具特异性，可能仍无法确诊。MRI是评估EPE的首选影像学检查方法。在MR检查方案中加入DWI序列，除了能无创地明确受累范围外，还能提高诊断准确性。
