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Clinical diagnosis
1%
1/102
Endometrial biopsy
66%
67/102
Laparoscopy
13%
13/102
MRI
6%
6/102
Transvaginal ultrasound
Select Answer to see Preferred Response
This patient is presenting with menstrual pain, pain during intercourse, pain with defecation, chest pain during her menses (suggesting lesions in her lungs), and an adnexal mass with a soft, tender, and boggy uterus (which could also suggest adenomyosis which may also present in endometriosis) which is suggestive of endometriosis. A definitive diagnosis of endometriosis requires laparoscopic examination with biopsy. Endometriosis is a benign condition that occurs when endometrial glands and stroma are located outside of the uterus, most commonly on the ovaries, the uterosacral and broad ligaments, and the cul de sac. Endometriosis classically presents with dysmenorrhea, dyspareunia, dyschezia, and infertility. The classic endoscopic finding of endometriosis is a chocolate cyst, which is a large implant on the ovary that is filled with blood. Both medical treatments (NSAIDS, OCPs, and GNRH agonists) and surgical treatments (laparoscopic ablation and total abdominal hysterectomy) are available. The diagnosis is suggested clinically; however, to confirm the diagnosis, laparascopy with biopsy must be performed. Incorrect Answers: Answer 1: Clinical diagnosis is incorrect as endometriosis is confirmed by laparoscopy and biopsy. Diagnoses that can be made clinically include cervicitis and erythema migrans (Lyme). Answer 2: Endometrial biopsy is the diagnostic test of choice for endometrial cancer which usually presents with painful vaginal bleeding in a postmenopausal woman. It can also be used to confirm the diagnosis of adenomyosis which frequently occurs in endometriosis; however, it would not confirm the diagnosis of endometriosis as there are lesions elsewhere/systemically. This patient's soft, boggy, and tender uterus suggests implantation of glands in the wall of the myometrium; however, her other symptoms including chest pain and adnexal pain makes the underlying diagnosis/etiology of her symptoms endometriosis. Answer 4: MRI can support the diagnosis of endometriosis but it is not the most accurate/confirmatory test. Answer 5: Transvaginal ultrasound can confirm intrauterine and ovarian pathologies and may demonstrate a chocolate cyst in this patient; however, it is not the confirmatory test for endometriosis. Bullet Summary: The confirmatory test for endometriosis is laparoscopy and biopsy.
4.2
(15)
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