Findings:
Both ovaries appear enlarged and in close proximity, located in the rectouterine space, each containing multiple, thick-walled, cystic lesions with hyperintense signal on T1 fat-sat, corresponding to a heterogeneously hypointense signal on T2-weighted images and partial diffusion restriction, consistent with bilateral ovarian endometriomas. The lesions measure up to 7.2 x 8.5 x 8.5 cm on the right and 4.2 x 6 x 5.5 cm on the left.
Tortuous dilated fallopian tubes, measuring around 1.8 cm in maximal diameter, with possible T1 hyperintense internal contents on the right side, best seen on T1 FS, suggestive of tubal blood, in keeping with right-sided hematosalpinx.
Anteverted anteflexed uterus with focal thickening of the endometrial-myometrial junctional zone invading the myometrium (thickness = 42 mm) of left lateral corporeal location in keeping with focal adenomyosis.
Tortuous dilated parametrial venous structures with associated dilatation of both ovarian veins, suggestive of pelvic congestion.
No free fluid. No lymphadenopathy.
No bony abnormality is seen.
Conclusion:
Bilateral multiple ovarian endometriomas with right-sided hematosalpinx. Additional focal adenomyosis of the left lateral uterine wall. No free fluid, no lymphadenopathy.