Is endometriosis always seen in a transvaginal ultra sound?

Rarely: Unless there is an endometrioma (an endometriosis cyst) is present, it is unusual to be able to see endometriosis on ultrasound.

No: The definitive diagnosis of endometriosis requires surgical evaluation ofdthe pelvis. There are findings on pelvic exam and on pelvic ultrasound that would suggest endometriosis, but that would be presumptive.