Purpose
Endometriosis is a benign gynecological disease, affecting women of reproductive age and characterized by the proliferation of endometrial tissue outside the uterine cavity, whose diagnosis is not easy since symptoms often appear as a severe discomfort during menstrual cycle, with consequent misunderstanding [1].
It presents as superficial peritoneal implants or as lesions located on the ovaries (endometrioma) or as deeply invasive nodules that can infiltrate different organs such as rectum, uterus and bladder, compromising their functionality [2].
Endometriosis is associated with chronic pelvic pain, dysmenorrhea,...
Methods and materials
We studied twelve cases of endometriosis in patients suffering from lumbar pain radiated to the lower limb identified through MRI, but we will describe only the two we believe most significant.
Results
Case 1
A 45-year-old woman underwent a lumbar spine MRI in our Diagnostic Imaging Department because of a progressive worsening of low back pain, sciatica-like, extended to the left lower limb.
The previous MRI examination, performed five years before, revealed the presence of disc protrusions at L3-L4 and L5-S1, without significant radiologic signs of radicular impingement. A Tarlov cyst of about 5.5x2.5cm was supposed at S2. Besides, some collateral findings were demonstrated: a retroverse uterus surrounded by little myomatus-like signal anomalies, a big cyst-like lesion...
Conclusion
Sciatica is most commonly due to lumbar spine pathology or sciatic nerve injury and most clinicians look for musculoskeletal pathologies to justify leg pain, but other causes of intraneural mass-like enlargement have to be taken into consideration, such as endometriosis and piriformis syndrome.
The piriformis muscle runs from the anterior sacral vertebrae to the greater trochanter, passing through the greater sciatic foramen [10]. The sciatic nerve is typically placed inferiorly to the piriformis muscle, but occasionally the nerve goes through the muscle fibers: this proximity...
Personal information and conflict of interest
A. Francavilla; Foggia/IT - nothing to disclose P. Milillo; Foggia/IT - nothing to disclose A. N. Cintoli; Foggia/IT - nothing to disclose C. Bristogiannis; Foggia/IT - nothing to disclose L. P. Stoppino; Foggia/IT - nothing to disclose R. Vinci; Foggia/IT - nothing to disclose L. Macarini; Foggia/IT - nothing to disclose
References
[1] Greene R., Stratton P., Cleary S. D., Ballweg M. L. & Sinaii N. - Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertility and Sterility2009;91(1):32–39;
[2] Schreinemacher MH, Backes WH, Slenter JM, Xanthoulea S, Delvoux B, et al. (2012) - Towards Endometriosis Diagnosis By Gadofosveset-Trisodium Enhanced Magnetic Resonance Imaging. PloS ONE 7(3): e33241. DOI:10.1371/journal.pone.0033241;
[3] Tosti C, Pinzauti S, Santulli P, et al. (2015) - Pathogenetic Mechanisms of Deep Infiltrating Endometriosis. DOI:10.1177/1933719115592713;
[4] Salazar-Grueso E, Roos R. - Sciatic endometriosis: a treatable sensorimotor...