Endometriosis differential diagnosis
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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 causes dysmenorrhea and dyspareunia. Endometriosis must be differentiated from other conditions presenting with dyspareunia and dysmenorrhea 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. The following table is a description of the various diseases that cause abnormal uterine bleeding.
Differentiating Endometriosis on the Basis of Abnormal Uterine Bleeding:
Clinical Features | Physical Examination | Diagnostic Findings | |
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Endometriosis |
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|
|
Adenomyosis[1] |
|
|
|
Submucous uterine leiomyomas[2] |
|
|
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Pelvic inflammatory disease[3] |
|
|
|
Pelvic congestion syndrome[4] |
|
|
|
Differentiating Endometriosis on the Basis of Lower Abdominal Pain:
Endometriosis can also be differentiated from conditions that present with lower abdominal pain in young women. The following is a list of diseases that present with acute onset severe lower abdominal pain:
Disease | Findings |
---|---|
Ectopic pregnancy | History of missed menses; positive pregnancy test; ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[5] |
Appendicitis | Pain localized to the right iliac fossa; vomiting; abdominal ultrasound sensitivity for the diagnosis of acute appendicitis is 75% to 90%.[6] |
Rupturedovarian cyst | Usually spontaneous; can follow the history of the trauma; mild chronic lower abdominal discomfort may suddenly intensify; ultrasound is diagnostic.[7] |
Ovarian cyst torsion | Presents with acute severe unilateral lower quadrant abdominal pain, nausea, and vomiting; tender adnexal mass palpated in 90%; ultrasound is diagnostic.[8] |
Hemorrhagic ovarian cyst | Presents with localized abdominal pain, nausea, and vomiting; Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings; ultrasound is diagnostic.[8] |
Endometriosis | Presents with cyclic pain that is exacerbated by the onset of menstruation and dyspareunia. Laparoscopic exploration is diagnostic.[8] |
Acute cystitis | Presents with features of increased urinary frequency, urgency, dysuria, and suprapubic pain.[9][10] |
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.
- ↑ Morin L, Cargill YM, Glanc P (2016). "Ultrasound Evaluation of First Trimester Complications of Pregnancy". J Obstet Gynaecol Can. 38 (10): 982–988. doi:10.1016/j.jogc.2016.06.001. PMID 27720100.
- ↑ Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994). "Acute appendicitis: CT and US correlation in 100 patients". Radiology. 190 (1): 31–5. doi:10.1148/radiology.190.1.8259423. PMID 8259423.
- ↑ Bottomley C, Bourne T (2009). "Diagnosis and management of ovarian cyst accidents". Best Pract Res Clin Obstet Gynaecol. 23 (5): 711–24. doi:10.1016/j.bpobgyn.2009.02.001. PMID 19299205.
- ↑ 8.0 8.1 8.2 Bhavsar AK, Gelner EJ, Shorma T (2016). "Common Questions About the Evaluation of Acute Pelvic Pain". Am Fam Physician. 93 (1): 41–8. PMID 26760839.
- ↑ {{Cite journal | author = W. E. Stamm | title = Etiology and management of the acute urethral syndrome | journal = Sexually transmitted diseases | volume = 8 | issue = 3 | pages = 235–238 | year = 1981 | month = July-September | pmid = 7292216
- ↑ {{Cite journal | author = W. E. Stamm, K. F. Wagner, R. Amsel, E. R. Alexander, M. Turck, G. W. Counts & K. K. Holmes | title = Causes of the acute urethral syndrome in women | journal = The New England journal of medicine | volume = 303 | issue = 8 | pages = 409–415 | year = 1980 | month = August | doi = 10.1056/NEJM198008213030801 | pmid = 6993946