Ultrasound evaluation of deeply infiltrative endometriosis: technique and interpretation

  • Luciana Pardini ChamiéEmail author
Special Section: Endometriosis


Endometriosis is a common benign gynecological condition defined as the presence of endometrial tissue located outside the uterus and frequently associated with chronic pelvic pain and infertility. It is a polymorphic disease that can be presented as superficial implants, endometriomas and deep lesions that infiltrate the peritoneal surface associated with fibrosis and inflammatory reaction. Diagnosis of deep endometriosis is difficult and delayed, frequently missed in a routine ultrasound. Transvaginal ultrasound is the first-line imaging modality to investigate endometriosis and when performed by an expert in female pelvic imaging can provide a reliable mapping of the affected sites. Bowel preparation can be used to improve the detection of bowel lesions as well as the other sites affected by eliminating artifacts. Surgery has been the mainstay to treat symptomatic endometriosis and preoperative imaging mapping is crucial for better results and to reduce residual disease. The goals of surgery include radical removal of all lesions and the restoration of normal pelvic anatomy. The author describes technical aspects and imaging interpretation of the transvaginal sonography to investigate deeply infiltrative endometriosis.


Transvaginal sonography Bowel preparation Deeply infiltrative endometriosis Bowel endometriosis Endometrioma 


Supplementary material

Video 1. Assessment of the anterior compartment in the sagittal plane. (AVI 4790 kb)

Video 2. Assessment of sliding sign in the anterior compartment (uterovesical region). (AVI 6972 kb)

Video 3. Assessment of sliding sign in the right ovary. (MOV 1076 kb)

Video 4. Assessment of the left ureteral path in a retrograde manner from the vesicouterine junction up to the adnexal region. (AVI 2413 kb)

Video 5. Assessment of the left ureteral peristalsis. (MOV 1457 kb)

Video 6. Assessment of the ureteral jet through power Doppler. (AVI 1493 kb)

261_2019_2322_MOESM7_ESM.mp4 (6.6 mb)
Video7. Assessment of the posterior compartment by sliding the probe into the posterior vaginal fornix. (MP4 6756 kb)

Video 8. Assessment of the posterior compartment by sliding the probe from the anterior into the posterior vaginal fornix. (AVI 7498 kb)

Video 9. Assessment of the right uterosacral ligament. (AVI 6882 kb)

Video 10. Assessment of the left uterosacral ligament. (AVI 4057 kb)

Video 11. Assessment of the vagina. (AVI 6904 kb)

Video 12. Assessment of the rectosigmoid colon. (AVI 7524 kb)

Video 13. Assessment of DIE affecting the ovarian fossae and its proximity to the left ureteral path. (AVI 4556 kb)

Video 14. Assessment of retrocervical DIE. (AVI 6922 kb)

Video 15. Assessment of vaginal DIE associated with a right retrocervical lesion. (AVI 7452 kb)

Video 16. Assessment of bowel DIE affecting the rectosigmoid colon up to the submucosal layer. (AVI 5253 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic ImagingChamié Imagem da MulherSão PauloBrazil
  2. 2.Department of Diagnostic ImagingFleury Medicina e SaúdeSão PauloBrazil

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