Endometriosis is a chronic disease characterized by ectopic endometrial tissue that can cause pelvic pain and infertility. Almost 10% of reproductive age women have endometriosis. Definitive diagnosis requires surgical intervention and histological confirmation is advisable. As a result, there is a long delay between onset of symptoms and diagnosis. Ultrasound has been used for a long time to evaluate the pelvis and locate endometriotic lesions. Ovarian endometriotic cysts represent the classical form of endometriosis that can be sonographically seen and are correctly diagnosed by transvaginal ultrasound (TVUS) in almost 90% of the cases. Recently, TVUS has been reported as an excellent tool to diagnose deeply infiltrating lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid as well as vesical wall) with good accuracy. Present evidence suggest that TVUS should be the first-line exam in the workup of patients with suspected endometriosis.
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