Endometriosis differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Endometriosis is a cause of dysmenorrhea and dyspareunia, it must be differentiated from other conditions presenting with similar features such as adenomyosis, pelvic inflammatory disease, pelvic congestion syndrome and sub mucosal uterine fibroids. | [[Endometriosis]] is a cause of [[dysmenorrhea]] and [[dyspareunia]], it must be differentiated from other conditions presenting with similar features such as [[adenomyosis]], [[pelvic inflammatory disease]], pelvic congestion syndrome and sub mucosal uterine [[fibroids]]. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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!Diagnostic Findings | !Diagnostic Findings | ||
|- | |- | ||
|Endometriosis | |[[Endometriosis]] | ||
| | | | ||
*Dysmenorrhea | *[[Dysmenorrhea]] | ||
*Dyspareunia | *[[Dyspareunia]] | ||
*Infertility | *[[Infertility]] | ||
*Common in women between 25 to 35 years | *Common in women between 25 to 35 years | ||
| | | | ||
*Nodules in the posterior fornix | *Nodules in the [[posterior fornix]] | ||
*Adnexal masses | *Adnexal masses | ||
*Fixed retroverted uterus | *Fixed retroverted [[uterus]] | ||
*Lateral displacement of the cervix | *Lateral displacement of the [[cervix]] | ||
| | | | ||
*Increased serum cancer antigen- | *Increased [[CA-125|serum cancer antigen-125]] | ||
*Nodules of the | *Nodules of the recto vaginal septum and hypoechoic, vascular mass on [[MRI]] | ||
*Laproscopic visualization confirms the diagnosis | *Laproscopic visualization confirms the diagnosis | ||
|- | |- | ||
|Adenomyosis<ref name="pmid16782099">{{cite journal| author=Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P| title=Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. | journal=Fertil Steril | year= 2006 | volume= 86 | issue= 3 | pages= 711-5 | pmid=16782099 | doi=10.1016/j.fertnstert.2006.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782099 }}</ref> | |[[Adenomyosis]]<ref name="pmid16782099">{{cite journal| author=Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P| title=Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. | journal=Fertil Steril | year= 2006 | volume= 86 | issue= 3 | pages= 711-5 | pmid=16782099 | doi=10.1016/j.fertnstert.2006.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16782099 }}</ref> | ||
| | | | ||
*Abnormal uterine bleeding | *[[Abnormal uterine bleeding]] | ||
*Dysmenorrhea | *[[Dysmenorrhea]] | ||
*Common in women aged 40 and 50 years | *Common in women aged 40 and 50 years | ||
| | | | ||
*Asymmetric thickening of the | * Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of [[gestation]] | ||
| | |||
*Asymmetric thickening of the [[myometrium]] on [[MRI]] | |||
|- | |- | ||
|Submucous uterine leiomyomas<ref name="pmid26477496">{{cite journal| author=Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J et al.| title=Long-term medical management of uterine fibroids with ulipristal acetate. | journal=Fertil Steril | year= 2016 | volume= 105 | issue= 1 | pages= 165-173.e4 | pmid=26477496 | doi=10.1016/j.fertnstert.2015.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26477496 }}</ref> | |Submucous uterine [[Leiomyoma|leiomyomas]]<ref name="pmid26477496">{{cite journal| author=Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J et al.| title=Long-term medical management of uterine fibroids with ulipristal acetate. | journal=Fertil Steril | year= 2016 | volume= 105 | issue= 1 | pages= 165-173.e4 | pmid=26477496 | doi=10.1016/j.fertnstert.2015.09.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26477496 }}</ref> | ||
| | | | ||
*Menorrhagia | *[[Menorrhagia]] | ||
*Pelvic pressure and pain | *Pelvic pressure and pain | ||
*Infertility | *[[Infertility]] | ||
*Peak age of onset 25 to 44 years of age | *Peak age of onset 25 to 44 years of age | ||
| | | | ||
*Mobile uterus with an irregular contour | *Mobile [[uterus]] with an irregular contour | ||
| | | | ||
*Transvaginal ultrasound will demonstrate the presence of myomas | *[[Transvaginal ultrasound]] will demonstrate the presence of myomas | ||
|- | |- | ||
|Pelvic Inflammatory disease<ref name="pmid24216035">{{cite journal| author=Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections| title=2012 European guideline for the management of pelvic inflammatory disease. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 1 | pages= 1-7 | pmid=24216035 | doi=10.1177/0956462413498714 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24216035 }}</ref> | |[[PID|Pelvic Inflammatory disease]]<ref name="pmid24216035">{{cite journal| author=Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections| title=2012 European guideline for the management of pelvic inflammatory disease. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 1 | pages= 1-7 | pmid=24216035 | doi=10.1177/0956462413498714 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24216035 }}</ref> | ||
| | | | ||
*Seen in patients with history of sexually transmitted disease | *Seen in patients with history of [[sexually transmitted disease]] | ||
*History of multiple sexual partners | *History of multiple sexual partners | ||
*Common in women younger than 25 years of age | *Common in women younger than 25 years of age | ||
| | | | ||
*Abdominal | *[[Abdominal tenderness]] | ||
*Acute cervical motion, uterine, and adnexal tenderness | *Acute [[Cervical motion tenderness|cervical motion]], [[Uterus|uterine]], and adnexal tenderness | ||
*Visualization of | *Visualization of purulent endocervical discharge | ||
| | | | ||
*Positive Nucleic acid amplification tests | *Positive [[Nucleic acid test|Nucleic acid amplification tests]] for [[Chlamydia trachomatis]] and [[Neisseria gonorrhoeae|N. gonorrhoeae]] | ||
*Gram negative diplococci on gram stain | *Gram negative [[diplococci]] on [[gram stain]] | ||
|- | |- | ||
|Pelvic congestion Syndrome<ref name="pmid11133549">{{cite journal| author=Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES| title=Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. | journal=AJR Am J Roentgenol | year= 2001 | volume= 176 | issue= 1 | pages= 119-22 | pmid=11133549 | doi=10.2214/ajr.176.1.1760119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11133549 }}</ref> | |Pelvic congestion Syndrome<ref name="pmid11133549">{{cite journal| author=Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES| title=Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women. | journal=AJR Am J Roentgenol | year= 2001 | volume= 176 | issue= 1 | pages= 119-22 | pmid=11133549 | doi=10.2214/ajr.176.1.1760119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11133549 }}</ref> | ||
| | | | ||
*Shifting lower abdominal pain | *Shifting lower abdominal pain | ||
*Deep dyspareunia | *Deep [[dyspareunia]] | ||
*Post-coital pain | *Post-coital pain | ||
*Exacerbation of pain after prolonged standing | *Exacerbation of pain after prolonged standing | ||
| | | | ||
*Bimanual tenderness | *Bimanual tenderness | ||
*Cervical motion tenderness | *[[Cervical motion tenderness]] | ||
| | | | ||
*Pelvic varicosities on ultrasound with reduced blood flow | *Pelvic [[varicosities]] on ultrasound with reduced blood flow | ||
|} | |} | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 15:05, 20 June 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Endometriosis is a cause of dysmenorrhea and dyspareunia, it must be differentiated from other conditions presenting with similar features such as adenomyosis, pelvic inflammatory disease, pelvic congestion syndrome and sub mucosal uterine fibroids.
Differential Diagnosis
Endometriosis is a cause of abnormal uterine bleeding and can result in infertility. There are several diseases which can result in excessive uterine bleeding and the following table is a description of various causes of excessive uterine bleeding.
| Clinical Features | Physical Examination | Diagnostic Findings | |
|---|---|---|---|
| Endometriosis |
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| Adenomyosis[1] |
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| Submucous uterine leiomyomas[2] |
|
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| Pelvic Inflammatory disease[3] |
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| Pelvic congestion Syndrome[4] |
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References
- ↑ Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P (2006). "Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis". Fertil Steril. 86 (3): 711–5. doi:10.1016/j.fertnstert.2006.01.030. PMID 16782099.
- ↑ Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J; et al. (2016). "Long-term medical management of uterine fibroids with ulipristal acetate". Fertil Steril. 105 (1): 165–173.e4. doi:10.1016/j.fertnstert.2015.09.032. PMID 26477496.
- ↑ Ross J, Judlin P, Jensen J, International Union against sexually transmitted infections (2014). "2012 European guideline for the management of pelvic inflammatory disease". Int J STD AIDS. 25 (1): 1–7. doi:10.1177/0956462413498714. PMID 24216035.
- ↑ Rozenblit AM, Ricci ZJ, Tuvia J, Amis ES (2001). "Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women". AJR Am J Roentgenol. 176 (1): 119–22. doi:10.2214/ajr.176.1.1760119. PMID 11133549.