Endometriosis UK
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What doesn’t show up on an ultrasound?

Hi, I’ve read lots of people on here saying when they’ve had their laparoscopy their ovary was stuck or twisted or something was stuck to their bladder or other things were stuck etc.

I’m wondering do these kind of things not show up on ultrasounds?

I know endometriosis doesn’t show up well in ultrasounds but I’m just interested to find out what else didn’t show up until laparoscopy even though you had had an ultrasound?

Ive had an ultrasound in August and the only thing noted was an enlarged right ovary. Every thing else appeared normal.

My laparoscopy is booked for beginning of December.

So I’m just looking for advice from anyone who had a relatively normal ultrasound but their laparoscopy told a different story.

I’m starting to get concerned that although I don’t want them to find anything wrong, they won’t find anything at all and I won’t get any explanation for my pain and horrendous bleeding 😩

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I'm a Radiographer and ultrasounds are only good for specific findings. Laparoscopy is the gold standard in diagnosing endometriosis and I've had stage 4 endometriosis and 3 laps and all my ultrasounds were normal but after laparoscopy they found it was stage 4 and everything stuck to each other severely. Ultrasound is good for endo on the bladder but terrible for endo on the bowel. MRI can only show so much also and your normal bowel can get in the way of both MRI and ultrasound making it hard to see what you need to see. I had an MRI and they found a large nodule that they never even saw in my lap, so no mode of imaging or surgery will show you what you need clearly, so it's good to get a few different modes of imaging. Also it has been my experience that when surgeons and radiologist say there is absolutely nothing there, it is a blatant lie, and they cannot justify it at all, no one can clearly make that diagnosis at any time. But I'd say get an MRI and then a lap if it's causing terrible pain and suffering for you, it's the best diagnostic tool but as I said, in no way perfect xx

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Thank you so much for your reply. I’m having another ultrasound before my lap.

In your experience what would the most common reason for an enlarged ovary be? I have already been diagnosed with polycystic ovaries.

I have no medical knowledge but just seems like an ovary being stuck to something would show up! Anyway I guess I’ll just have to see in December! thanks again x

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Enlarged ovaries can be from many causes, most of them are normal or harmless :) PCOS is a cause of enlarged ovaries to begin with so it may just be because of your diagnosis with PCOS. It's when you have more worrying signs that have come on suddenly and are unrelated along with enlargement, like fevers, vomitting and nausea, weight loss, unusual to normal or more severe pain and unusual or sudden heavy bleeding that you may start to worry. Otherwise I wouldn't worry too much unless your GP has given you reason to. It may also be caused by a cyst on your ovary but ultrasound is very good at picking these up so they would have ruled that out on your ultrasound. Endometriosis is one of those really frustrating and confusing diseases that no one will ever have answers for. All my specialists have given up because they can't help or figure it out. I'm still finding someone who will break the trend of unhelpful medical people to find an answer for my pain and suffering, it will always be an ongoing thing. Also, it's never a bad thing to have an ultrasound, they're harmless, no radiation and they serve mostly to rule out everything that could be acutely wrong, so that's good in a way cause you know there will be nothing too acute and severely wrong with a sinister cause. It's the chronic pain which is harder to determine and treat. Good luck, all the best for your surgery in December x

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Thank you so much x

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Transvaginal ultrasound will show ovarian endo (endometriomas) and otherwise endo that has caused the anatomy to altered, such as bowel endo narrowing the lumen of the bowel. Peritoneal endo lesions will not show unless they are deply infiltrating. It is very operator dependent though, and it is vital that the scan is carried out by a sonographer who has expertise in diagnosing endo.

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Thank you, I’ve got an ultrasound coming up but I’ve requested not to have transvaginal as I don’t think I’ll cope with the pain I’m in, hopefully they will be able to find the cause of the pain during the laparoscopy and hysteroscopy. 😩

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Hi there,

Unfortunately many things do not show up on an ultrasound. I have had many normal looking ultrasounds and a lot of damage done by endometriosis and adhesions. My OB/GYN explained that it is very rare to see this kind of damage with an ultrasound which makes endometriosis hard to diagnose without surgery.

I know that the thought of surgery can be very frightening but it is necessary moving forward.

Try not to worry while you wait and take good care of yourself.

Wishing you the very best of luck.

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Thank you, I didn’t realise there were so many things that didn’t show up on ultrasound! All that damage that you describe sounds like you would be able to see that! Hopefully I’ll have answers soon! 😊

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In my initial ultrasound done at my local hospital back in 2015 (when I was still trying to get diagnosed) they found a hydrosalpinx in my right tube and a couple of what they called paraovarian cysts which they said were small and nothing to worry about. I was told the scan was normal, that it didn't warrant a referral to gynae, and to go back to my GP (I have since been told that I should have been referred to a gynae at that point because a hydrosalpinx is not normal and should not be ignored).

At my first lap they found stage 4/severe endo. My ovaries were stuck to the back of my uterus and I had what they call a frozen pelvis, where the uterus and bowel are stuck together.

I then had an ultrasound scan at a bsge centre with an endo specialist where they found 4 large endo nodules and adenomyosis, so far more endo than had been found during the first lap. I then went on to have an exploratory lap with them and they found even more endo on my bladder which had not shown up in either scan as it was too small.

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Thank you so much for sharing your experience. As I have said, I have no medical knowledge whatsoever, so I don’t really understand about it all, but it just baffles me that your ovaries can be stuck behind the uterus and that, that doesn’t show up on an ultrasound! 🤔

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Hi,

I had a laparoscopy about three years ago after insisting on one based on my symptoms. My ultrasounds all showed nothing at all but when I had the laparoscopy I had endometriosis which partially explained symptoms which needed treatment. So the basic belief that endo is not visible on ultrasounds is very true! Laparoscopy's are very useful in identifying causes behind symptoms in much more detail and helping to eliminate these.

All the best

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