Fallopian tubes endometriosis mistaken for bilateral ovarian tumors

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We present the case of a 26 years old women with severe persistent pelvic pain. The MRI showed both ovaries with multiple cysts and at least two right ovarian nodular lesions, hypointense in T2 and hyperdense in T1, measuring 8 mm and 14 mm in diameter; two other lesions with similar characters were observed at the bottom of the Douglas pouch; images were suggestive of ovarian endometriomas (Figure 1). The CA 125 level was 19,8 UI/ml. The pelvic ultrasound showed normal uterus with two ovarian tumours, of 65/46 mm on the right side and 56/48 mm on the left side, both being complex formations that included endometriotic cysts and non-homogeneous cystic masses with thickened walls and positive Doppler signal. The laparoscopic approach was decided for diagnosis and treatment. The intraoperative pelvis inspection showed macroscopic normal ovaries,  with dilated-violet fallopian tubes filled with blood products (seen at the neosalpingostomy) (Figure 2),  along with severe adhesions on the left side between the left adnexa and the sigmoid colon and multiple endometriotic implants on the peritoneal surface (Figure 3), which were treated by fulguration. These findings were surprising when compared with the preoperative exam, and we concluded that the heterogeneous signal intensity on both MRI and sonography resulted from the varying ages of the contained blood products in the fallopian tubes, as the patient was first diagnosed with ovarian mass 5 years prior to surgery.