19/03/2025
Indian Head Dress Sign in Deep Infiltrating Endometriosis
The "Indian headdress sign" on transvaginal ultrasound (TVS) in deep infiltrating endometriosis (DIE) refers to hypoechoic, irregular structures resembling an "Indian headdress" or "moose antler" due to endometriotic deposits causing retraction and adhesions in the re**um.
Here's a more detailed explanation:
What it is:
The "Indian headdress sign" appears on TVS as hypoechoic (darker) areas with irregular shapes, often with thin, band-like echoes radiating outwards, resembling an Indian headdress or moose antlers.
What causes it:
This sign is a result of endometriotic tissue infiltrating the bowel wall, causing retraction and adhesion of the muscularis propria, which is the normal muscular layer of the re**um.
Why it's important:
The "Indian headdress sign" is a valuable indicator of deep endometriosis, particularly in the rectosigmoid area, and can help guide further diagnosis and treatment.
Other names:
This sign is also sometimes referred to as the "moose antler sign".
How it's seen:
During a transvaginal ultrasound (TVS), the bowel wall lesions appear as hypoechoic (darker) and solid, focal, and tubular with slightly irregular margins. In some cases, a thinner section or a "tail" may be noted at one end, resembling a "comet".
Other signs of deep endometriosis:
Other sonographic features of deep endometriosis include obliteration of the pouch of Douglas, a negative "sliding sign" (where the re**um and uterus do not slide freely against each other), and hypoechoic nodules in the rectovaginal septum.
Diagnosis:
While TVS is a valuable tool for detecting deep endometriosis, the gold standard for diagnosis remains visual inspection by laparoscopy, preferably with histological confirmation.
