CASE 1154 Published on 11.11.2001

Hematometra and vaginal atresia

Section

Genital (female) imaging

Case Type

Clinical Cases

Authors

O. Kilickesmez (1), A. Y. Barut (1), D. Arikan (2)

Patient

15 years, female

Categories
No Area of Interest ; Imaging Technique MR
Clinical History
A 15 years-old female patient referred to the hospital with delayed menarche, pelvic discomfort and lower abdominal pain increasing for the last 2 months.
Imaging Findings
A 15 years-old female patient referred to the hospital with delayed menarche, pelvic discomfort and lower abdominal pain increasing for the last 2 months. In the physical examination of the patient vaginal introitus appeared rudimentary with a depth of 1 cm. hymen seemed hypoplasic. An MRI study of the patient with 1.5 T MR scanner, in three planes with SE T1 ( TR:560, TE: 15.0/1), FSE T2 ( TR : 3850, TE : 99.0/1) sequences were performed. The MR pictures showed an enlarged uterus. A hyperintense collection on all sequences in the uterine cavity was observed. The fluid in the cavity is thought to be subacute blood products.The thickness of the myometrium was markedly decreased. Final diagnosis was made as complete vaginal atresia after laparoscopy. Ovaries and fallopian tubes were normal. Than Mc Indoe vaginoplasty was performed for the treatment.
Discussion
Genital tract obstruction results in the accumulation of secretions, blood, or both in the uterus and/or vagina, with the location depending on the amount of obstruction. Premenarcheally the retained material is secretion(hydrometrocolpos), whereas postmenarcheally menstrual blood is added in this collection(hematometrocolpos). Obstruction may be either congenital like; vaginal atresia, vaginal septum, imperforate hymen, labial agglutination, imperforate cervix. A defect or arrest in the normal downward growth of the fused paramesonephric ducts toward the urogenital sinus could explain agenesis or dysgenesis of the müllerian portion of the vagina and the uterus. Patients usually do have some degree of absence of the uterus, so that a more accurate term might be partial aplasia or dysplasia of the müllerian ducts, as the condition represents the absence of müllerian portion of the vagina. By common although incorrect usage, the term “congenital absence of the vagina” also known as the Mayer Rokitansky Küster Hauser syndrome refers to that condition which represents as a blindly ending shallow vagina, absence of the upper vagina and partial or complete absence of the uterine cervix and corpus. Mc Kusick Kaufman syndrome is also a rare condition recessively inherited. The disease includes vaginal atresia associated with hydrometrocolpos, uterovaginal duplications and other abnormalities. Problems of vertical fusion primarily involve the vagina and represent faults in the junction between the downgrowing müllerian ducts and the upgrowing derivative from the urogenital sinus; this may cause a transverse vaginal septum. Problems of lateral fusion may involve all or part of the pair müllerian system. Fusion begins caudally and extends cranially; if there is incomplete fusion, it will most likely be seen in the upper system, causing duplication of the upper uterus. Problems with lateral fusion may result in partial or complete duplication of the uterus. Acquired causes of the obstruction are neoplastic obstruction of endocervical canal, postradiation fibrosis, scarring after infection or surgery. Vaginal agenesis is the second most common cause of primary amenorrhea. Incidence is 2 in 10,000 women. The most common symptom of the disease is cyclic abdominal pain. It may be associated with uterine or other organ system anomalies. The treatment is surgery. If the obstruction is at the vaginal level, there is marked distention of vagina and endometrial cavity with fluid. The diagnosis of the disease is usually made by the clinical history and sonographic findings. Transperineal sonography may be more useful certainly for searching the cause of the disease. MRI provides more information especially about the content of the fluid and may show more anatomic detail with three planar imaging. Also in the acquired hematometra, primary causes such as malignancies or infections may be established.
Differential Diagnosis List
Hematometra
Final Diagnosis
Hematometra
Case information
URL: https://www.eurorad.org/case/1154
DOI: 10.1594/EURORAD/CASE.1154
ISSN: 1563-4086