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High‐frequency power Doppler angiographic appearance and microvascular flow velocity in recurrent scar endometriosis

Endometrial tissue has been identified in numerous surgical or procedure-related scars, including Cesarean section scar1,2, laparoscopic trocar tract2, amniocentesis needle tract3, and perineal episiotomy incision scar4,5. The incidence of endometriomas associated with Cesarean section incision is approximately 0.03–0.4%1,6. The pathogenesis of scar endometriomas can be explained by iatrogenic transplantation of uterine tissue into the abdominal wall during surgery. Color Doppler in conjunction with gray-scale ultrasonography aids in vessel location and characterization of the vascular pattern. These techniques have been of great benefit in the differential diagnosis of pelvic masses. Compared with color Doppler, power Doppler is associated with a better sensitivity in detecting small vessels with lowvelocity flow. To our knowledge, this is the first report of a Cesarean scar endometrioma to be diagnosed by abdominal ultrasound and to be confirmed by pathology. The change in angiographic appearance demonstrated by power Doppler and microvascular blood flow velocity are also described.