Case Of the Week (COW) 23 Feb 2014
Answer:
HEMATOMETROCOLPOS DUE TO IMPERFORATE HYMEN WITH RIGHT HEMATOSALPINX
Findings:
The following were the observations in this adoloscent girl clinically presenting with Amenorrhoea: The vagina is significantly distended with Blood as reflected in the hyperintensity in fat suppressed T1W images Blood also noted within the endometrial cavity . No evidence of obvious Vaginal Septum . Cervix appears normal. Complex tubular right adnexal cystic lesion with septations and hemorrhage . Right Periovarian fluid noted . The urinary bladder is normal. Features consistent with HEMATOMETROCOLPOS DUE TO IMPERFORATE HYMEN. Complex right adnexal cystic lesion with septations and hemorrhage – Possible large Hematosalpinx with ovarian involvement.
Discussion:
Congenital vaginal obstruction most frequently results from imperforate hymen. The incidence of this disorder is estimated to be 0.1% of term female neonates. The clinical presentation depends primarily on patient’s age: female infants will present with symptoms of hydrocolpos, mucocolpos or hydrometrocolpos due to the stimulation of vaginal secretions from maternal hormones adolescent girls will present with symptoms related to primary amenorrhoea and haemato(metro)colpos Accumulating menstrual blood and resulting haemato(metro)colpos will mechanically compress the urethra leading to bladder outlet obstruction Prompt diagnosis is crucial to avoid complications such as endometriosis, infertility and ectopic pregnancy The main role of imaging especially MRI is to differentiate hematocolpos due to imperforate hymen from a transverse vaginal septum or vaginal stenosis.
Ref: The role of MRI in young adolescent girls with hematocolpos European Journal of Radiology Extra, Volume 78, Issue 2, May 2011, Pages e97-e100 Eftychia et al
Answer:
HEMATOMETROCOLPOS DUE TO IMPERFORATE HYMEN WITH RIGHT HEMATOSALPINX
Findings:
The following were the observations in this adoloscent girl clinically presenting with Amenorrhoea: The vagina is significantly distended with Blood as reflected in the hyperintensity in fat suppressed T1W images Blood also noted within the endometrial cavity . No evidence of obvious Vaginal Septum . Cervix appears normal. Complex tubular right adnexal cystic lesion with septations and hemorrhage . Right Periovarian fluid noted . The urinary bladder is normal. Features consistent with HEMATOMETROCOLPOS DUE TO IMPERFORATE HYMEN. Complex right adnexal cystic lesion with septations and hemorrhage – Possible large Hematosalpinx with ovarian involvement.
Discussion:
Congenital vaginal obstruction most frequently results from imperforate hymen. The incidence of this disorder is estimated to be 0.1% of term female neonates. The clinical presentation depends primarily on patient’s age: female infants will present with symptoms of hydrocolpos, mucocolpos or hydrometrocolpos due to the stimulation of vaginal secretions from maternal hormones adolescent girls will present with symptoms related to primary amenorrhoea and haemato(metro)colpos Accumulating menstrual blood and resulting haemato(metro)colpos will mechanically compress the urethra leading to bladder outlet obstruction Prompt diagnosis is crucial to avoid complications such as endometriosis, infertility and ectopic pregnancy The main role of imaging especially MRI is to differentiate hematocolpos due to imperforate hymen from a transverse vaginal septum or vaginal stenosis.
Ref: The role of MRI in young adolescent girls with hematocolpos European Journal of Radiology Extra, Volume 78, Issue 2, May 2011, Pages e97-e100 Eftychia et al