Case 2

This is a pelvis MRI study, in a female patient of reproductive age (I would confirm the age by looking at patient data). I can appreciate linear, horizontal soft tissue thickening in the subcutaneous fat of the lower anterior abdominal wall, which represents typical post-operative changes of a cesarean section. There is focal thinning of the anterior uterine wall with associated invagination of the endometrial lining, also representing post cesarean section changes.

There is focal expansion forming a mass-like lesion at the right lower rectus abdominis muscle / sheath, anterior to the uterus and urinary bladder, showing heterogeneous signal intensity on the T2 weighted series. On the T1 weighted fatsat series, there are innumerable foci of markedly high T1 signal within this lesion – these indicate haemorrhagic foci. It shows avid heterogeneous contrast enhancement on the post gadolinium series. These features are characteristic of scar endometriosis.

I note a minimal amount of free fluid in the pelvis, which is most likely physiological. I also note the incidental finding of a cluster of simple cysts around the cervix, representing Nabothian cysts.

I would discuss the case with the referring physician, and recommend referral to the OBGYN service. While the conventional management of this condition is surgical, it can also be managed by interventional radiology using cryo-ablation. I would mention this to the referring physician.