Sonographic diagnosis of endometriosis and fibroids

Transvaginal ultrasound is considered the first-line imaging diagnostic test in the study of women with fibroids, adenomyosis, and ovarian and deep endometriosis. It is recom-mended that the ultrasound should follow the MUSA consensus for myometrial pathology, and the IDEA consensus for endometriosis. To diagnose adenomyosis, it is necessary to identify at least one << direct >> criterion (hypere-chogenic buds or island or intramyometrial cysts), as well as one or several << indirect >> criteria (globulous uterine morphology, << fan-shaped >> shadowing, asymmetry, or non-defined junctional zone). It is recommended to specify if the adenomyosis is internal or external. Translesional vascularization of adenomyosis is different from circumferential vascularization of fibroids, of which the measurement of the 3 diameters should be reported, the echogenicity should be described, and the number and location defined according to the FIGO classification. Ultrasound for endometriosis is performed by systematic examination of the uterus and ova-ries (endometriomas), soft markers (periadnexal pseudocysts, tabicated fluid in the pouch of Douglas, fixed ovaries, tenderness-guide areas, and comma-shaped uterus), sliding sign (ante-rior, retrouterine, and retrocervical) and the detection and description of deep endometriotic nodules in the anterior (bladder, ureters) or posterior compartment (uterosacral ligaments, parametria, vaginal fornix, rectovaginal septum, and rectosigma).(c) 2023 Elsevier Espana, S.L.U. All rights reserved.