Endometriomas, also known as chocolate cysts or endometriotic cysts.

Endometriomas, also known as chocolate cysts or endometriotic cysts.

This video shows Endometriomas, also known as chocolate cysts or endometriotic cysts.
The appearances of endometriomas can be quite variable. The classical example is a unilocular cyst with acoustic enhancement with diffuse homogeneous ground-glass echoes as a result of the hemorrhagic debris. This appearance occurs in 50% of cases.
The characteristic appearance of an endometrioma on sonography is that of a hypoechoic mass containing diffuse low-level internal echoes, the so-called “chocolate cyst.” However, many other appearances have been described, including an anechoic cyst, a solid-appearing mass, solid elements in a cyst.
Endometrioma is defined as either a unilocular mass with ground glass echogenicity and a color score between 1 and 3 (i.e. no vascularization to moderate vascularization) or a unilocular-solid mass with ground glass echogenicity with a papillary projection, a color score of 1 or 2, and no flow inside.
Scattered vascularity, one feature of adnexal endometriomas, may help to differentiate them from other lesions of dense vascular distribution, such as corpora lutea or ovarian neoplasms.
A general consensus is that ovarian endometriomas larger than 4 cm should be removed to reduce pain and improve spontaneous conception rates. The presence of small endometriomas (2–4 cm) does not reduce the success of in vitro fertilization (IVF) treatment.
Difference between endometriosis and Endometrioma
Endometriosis is the presence of endometrial glands and tissue outside the uterus. Women with endometriosis may have problems with fertility. Endometrioid cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches. Endometrioma is also referred to as an endometrioid cyst.
They are filled with dark brown endometrial fluid and are sometimes referred to as "chocolate cysts." The presence of endometriomas indicates a more severe stage of endometriosis. Endometriomas can lead to chronic pelvic pain and infertility, and often require surgery for treatment.
Endometriosis does not resolve on its own. If you experience pain and other symptoms, these symptoms will remain unless you receive treatment. In some cases, your symptoms may get worse.
Endometriotic cysts (endometriomas) generally occur within the ovaries and are the result of repeated cyclic hemorrhage within a deep implant. They may completely replace normal ovarian tissue. Cyst walls are generally thick and fibrotic and commonly have areas of discoloration and dense fibrous adhesions.
Bilateral homogeneous, hypoechoic cystic lesions adherent to each other at the midline. The close proximity of both ovaries is known as "Kissing Ovaries".

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