Clinical History
Abdominal painfull mass associated with menstrual pain
Imaging Findings
Abdominal pain in concomitance with the menstrual cycle; the symptoms remitted at the end of every cycle. Occasionally she had dysuria.
A lower abdominal palpable and painful mass was found at physical examination.
A compression due to an intrinsecal mass on the right wall of the upper vagina was observed at the vaginalscopy. US examination showed an oval, liquid mass, with low-level echoes in the pelvis and the emptiness of the right renal fossa.
MRI examination was then performed and revealed a complex congenital abnormality of the genitourinary tract (Fig.1).
Discussion
A uterus didelphys is a double uterus sometimes associated with a double cervix. In approximately 75% of cases, a thin wall separates the vagina into two parts. Most women with a uterus didelphys experience no symptoms though they may experience dyspareunia as a result of the vaginal wall.
The female genital tract develops almost entirely from the mullerian ducts, which appears about the sixth week of intrauterine life. In uterus didelphys with double cervix and vagina, there is complete failure of fusion of the two mullerian ducts.
The patients, adolescent or young women, usually present an history of normal menarche and a combination of pain, mass, and menstrual irregularities due to accumulation of retained menstrual fluid behind the occluding membrane. Urinary and lower intestinal symptoms may also be present.
When the genital tract is duplicated, there is no amenorrhea and the patient may have normal menstrual flow from the nonobstructed side. Females with congenital absence of a kidney have ipsilateral genital tract anomalies in about 50% of cases. Most patients receive a vaginal septum resection and have fairly good obstetrical outcomes, if properly diagnosed and treated.
Differential Diagnosis List
HEMATOMETROCOLPOS IN UTERUS DIDELPHYS
Final Diagnosis
HEMATOMETROCOLPOS IN UTERUS DIDELPHYS
