<b>Analysis of the Sonographic Appearance of Ovarian Endometriosis and Deep Infiltrating Endometriosis</b>

Background: Endometriosis is a chronic estrogen-dependent gynecological disorder commonly associated with pelvic pain, dysmenorrhea, dyspareunia, and infertility. Transvaginal ultrasonography is increasingly used as a first-line imaging modality for identifying ovarian endometriomas and deep infiltrating endometriosis. Objective: To analyze the sonographic features of ovarian endometriomas and deep infiltrating endometriosis among reproductive-age women undergoing pelvic evaluation at Shalamar Hospital, Lahore. Methods: This cross-sectional observational study included 42 women aged 18–45 years with symptoms suggestive of endometriosis. Participants underwent clinical assessment and transvaginal ultrasonography using a standardized pelvic scanning protocol. Ovarian morphology, lesion laterality, echogenicity, Doppler flow, deep pelvic compartment involvement, and clinical symptoms were recorded. Descriptive statistics were calculated, and reported associations were assessed using appropriate inferential tests. Results: Isolated ovarian endometrioma was identified in 21 participants (50.0%), isolated deep infiltrating endometriosis in 7 (16.7%), combined ovarian endometrioma and deep infiltrating endometriosis in 10 (23.8%), and no lesion in 4 (9.5%). Among 31 participants with ovarian endometrioma, ground-glass echogenicity was observed in 24 (77.4%) and minimal or peripheral Doppler flow in 25 (80.6%). Among 17 participants with deep infiltrating endometriosis, uterosacral ligament involvement was most frequent (70.6%), and all lesions were hypoechoic. Conclusion: Transvaginal ultrasonography provided clinically useful characterization of ovarian endometriomas and deep infiltrating endometriosis, supporting its role as a first-line imaging tool in symptomatic reproductive-age women.