History of long-standing endometriosis with known pelvic mass since 2012. Presenting with menorrhagia. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and enhancement without a focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Loss of signal on out of phase imaging compatible with diffuse fatty infiltration. Normally distended gallbladder without cholelithiasis.SPLEEN: Normal size spleen without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few bilateral cystic lesions are not completely characterized without contrast. One in the right interpolar region appears at least minimally complex. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal small and large bowel caliber. No significant free or loculated fluid collection. Small fat-containing umbilical hernia without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal basilar atelectasis.PELVIS:UTERUS, ADNEXA: The endometrial thickness is 10 mm, within normal limits. The inner myometrium/junctional zone is not well-defined with diffuse low signal intensity thickening of the uterine body particularly anteriorly with scattered T2 hyperintense foci compatible with diffuse adenomyosis.Small nabothian cysts.Well-defined 4.9 x 5.2 cm right uterine body subserosal mass is unchanged and likely a fibroid.In the rectouterine space there is a well-defined predominantly homogeneously T1 weighted hyperintense lesion with mild shading on T2-weighted imaging sequences. It is bilobed and measures 10.0 x 10.2 cm (series1501/38), not significantly changed from the prior study. However, it contains a large peripheral heterogeneous focal component which is partially exophytic measuring 6.9 x 4.5 cm (series 1601/40), increased from the prior study.The right and left adnexa are unremarkable in morphology size and signal intensity.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectouterine mass causes leftward mass effect on the sigmoid colon without evidence of invasion or obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.No significant change in the overall size of the large cul-de-sac mass. However, the complex heterogeneous focal component of this lesion demonstrates interval increase in size. No postcontrast images were obtained due to the patient's contrast allergy. The lesion appears distinct from the ovaries which are otherwise unremarkable. A large endometrioma remains on the differential. Although uncommon, malignant transformation cannot be excluded especially given the limitation of a nonenhanced examination and the interval increase in size a focal component of the dominant. Without the provided history of endometriosis, a hemorrhagic cystic neoplasm could not be excluded.2.Diffuse adenomyosis.3.Fatty liver.4.Incompletely characterized renal cystic lesions.