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Background
Endometriosis is the presence of functioning, hormonally-responsive endometrial stroma and glands outside the uterus. It affects up to 6 - 10% of reproductive age women, and can be involved in up to 50% of female infertility cases. Presenting signs and symptoms are variable and can include cyclical pelvic pain, infertility, and adnexal mass. Risk factors include anatomic abnormalities such as Mullerian duct anomalies, in utero exposure to diethylstilbestrol, and prolonged estrogen exposure. The objective of this study is to describe and demonstrate both common and unusual manifestations and complications of endometriosis.

Educational Goals / Teaching Points
Review the etiology, epidemiology, and various clinical presentations of endometriosis. Describe and demonstrate both common and unusual manifestations and complications. of endometriosis that should alert the radiologists to the possibility of including endometriosis in their differential diagnosis. Describe and demonstrate the radiological appearances of endometriosis on different modalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The current staging method for endometriosis is direct visualization during surgery. The American Society of Reproductive Medicine uses this revised scoring system to evaluate the stage of disease based on the location, type, depth and appearance, with a range from stage I (minimal disease) to stage IV (severe disease). Correct staging will be reviewed and illustrated. Transvaginal sonography, computed tomography (CT) and magnetic resonance imaging (MRI) are all commonly used modalities for detection of endometriosis and associated complications with 80 - 90% sensitivity and 60-98% specificity. Multi-system complications can involve the pelvis, mesentery, retroperitoneum, and thorax. Additionally, endometriosis can present in other clinical scenarios, including associations with adenomyosis, ovarian remnant syndrome, and Mullerian duct abnormalities. Core imaging modalities and associated common and uncommon pathologic findings will be reviewed.

Conclusion
Imaging modalities play a paramount role in the early diagnosis and prompt management of patients with endometriosis and its complications. Therefore it is critical that radiologists are well-versed with the different presentations, atypical locations, and complications of the disease, as described in this pictorial review.