0:01

Okay, so now we've seen a

0:02

nice case of kissing ovaries.

0:05

So the other two patterns in superficial

0:07

peritoneal disease include filmy

0:09

adhesions and candle wax phenomenon.

0:11

So I'll just talk a little bit about those.

0:14

So filmy adhesions are the presence of

0:17

web-like structures or wispy structures

0:20

floating around in free fluid.

0:21

And they really just are adhesions

0:24

that have developed as a reaction

0:26

to peritoneal endometriosis.

0:28

And because they're quite thin,

0:30

in this example, you can see this

0:32

adhesion here and maybe a little bit of

0:35

an adhesion here, they're quite thin.

0:37

So they're challenging to see on MRI.

0:40

So this is typically a finding that

0:43

is noted on ultrasound, particularly.

0:46

If you're scanning the patient, it

0:48

probably wouldn't necessarily get captured

0:50

on still images, but if you're scanning

0:52

the patient, you can certainly look for

0:54

these adhesions, and that's a good sign

0:56

of superficial peritoneal endometriosis.

1:00

And then the other feature in pattern two is the

1:03

presence of what's called candle wax phenomenon.

1:06

So it's a really nice description of what's

1:08

going on, and that is the presence of

1:11

multiloculated cystic structures that surround

1:13

an endometrioma due to repeated hemorrhage.

1:16

So as the bleeding happens over

1:19

time within the endometrioma.

1:21

We have some repeated areas of bleeding, and

1:24

then healing, bleeding, and then healing,

1:26

and that tends to accumulate around the ovary

1:28

itself, and that's what these areas are.

1:32

So this is a sign that we can sometimes see on

1:34

MRI, and if you look for that, and if you're

1:37

aware of it, you probably will find it, but

1:39

it's also quite often seen on sonography.

1:42

So once you have an endometrioma,

1:45

we don't just stop there.

1:46

We want to look outside the ovary.

1:47

We want to look for the

1:49

wispy or filmy adhesions.

1:51

And then we want to look at

1:52

the position of the ovaries.

1:53

Are they midline or are they in

1:55

their normal lateral position?

1:57

So those are the typical

1:58

manifestations of pattern two.