16 year old girl presenting with lower abdominal

 

Doctor's Information

Name : Morteza
Family :Sanei Taheri
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Hussein Soleiman Tabar

 

Patient's Information

Gender : Female
Age : 16

 

Case Section

Genital Female Imaging

 

Clinical Summary

16 year old girl presenting with lower abdominal pain and past history of transplant kidney. A sonography was performed and multicystic adnexal lesion was proposed. Then she referred for CT scan.

 

Images

 

Imaging Procedures and Findings

A dilated vagina containing fluid density with extension to uterine cavity is seen suggesting hematometrocolpos. Image 4 shows a cystic lesion posterior to symphisis pubis, this is definitely the patient??s dilated vagina (not bladder).In gynecology exam the diagnosis is proved.

 

Discussion

Obstruction of the female genital tract can occur at several levels and for several reasons. The term hydrome- trocolpos is often used to describe the physical exam and imaging findings related to the obstruction, and specif- ically describes dilatation of both the uterine cavity and vaginal lumen. If the obstruction only involves the uterus, then it is referred to as hydrometra, while dilatation of the vagina only is termed hydrocolpos. The enlarged uterus and vagina often result in a palpable midline pelvic mass. Extrinsic mass effect on the distal ureters can lead to hydroureteronephrosis, easily dem- onstrated on ultrasound. Plain films will show displace- ment of the bowel loops out of the pelvis by a soft tissue mass. Ultrasound reveals that the mass is actually a dilated uterus and/ or vagina . The luminal contents often have increased echoes, related to secre- tions and/ or blood products. In rare cases, the multipla- nar capabilities of MRI can be used to delineate the exact anatomy in question. Vaginal obstruction can be due to imperforate hymen or vaginal stenosis/atresia. The latter is a more serious diagnosis because it is associated with other congenital anomalies, including congenital heart dis- ease and gastrointestinal abnormalities.

 

Final Diagnosis

Imperforated hymen.

 

References

Caffey's pediatric diagnostic imaging-l0th ed./[edited by] jerald P. Kuhn, Thomas L.Siovis,jack O. Haller.

 

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