Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 10 6 2026 06 03 285 288 Emel Özalp Department of Obstetrics and Gynecology, Etlik City Hospital, Ankara, Türkiye. 2026 04 03 2026 04 26 Cesarean scar–related masses represent a diagnostic challenge due to overlapping clinical and imaging features. Scar endometriosis is often the leading consideration; however, other entities may closely mimic its presentation. We report the case of a 33-year-old woman with a history of three cesarean sections presenting with chronic pelvic pain and abnormal uterine bleeding. Imaging studies, including transvaginal ultrasonography and non-contrast magnetic resonance imaging (MRI), revealed a lesion at the cesarean scar highly suggestive of scar endometriosis. Based on these findings, surgical intervention was planned. Intraoperative exploration demonstrated a cystic lesion beneath the bladder peritoneum containing purulent material. Complete excision was performed. Histopathological examination confirmed abscess formation with no evidence of endometriosis. This case highlights the limitations of imaging in differentiating cesarean scar lesions and emphasizes the importance of considering chronic abscess in the differential diagnosis, particularly when laboratory findings are discordant or imaging is inconclusive. Surgical exploration remains essential for definitive diagnosis and management. https://crcp.tums.ac.ir/index.php/crcp/article/view/1178 https://crcp.tums.ac.ir/index.php/crcp/article/download/1178/765