75 Hematocolpos and Hematometra

CASE 75

Clinical Presentation

An adolescent girl presents with intermittent abdominal pain and a lower abdominal mass.

Figure 75A

Figure 75B

Figure 75C

Figure 75D

Radiologic Findings

On the axial T1-weighted image (Fig. 75A), two hyperintense structures, which represent a double vagina, are seen posterior to the bladder. On the axial T2-weighted image (Fig. 75B), the fluid collections in the vagina posterior to the bladder have varied signal, indicating subacute and more recent hemorrhage. (A second separate uterus not shown on these images was also present.) On the sagittal T1-weighted image (Fig. 75C), one vagina with very bright signal is seen to rise out of the pelvis. Another high-signal area seen posterior to the uterus, superior to the bright vaginal fluid in Fig. 75C, is a dilated fallopian tube. There is a small uterus anterosuperior to the vagina, which has similar signal to muscle on T1- and T2-weighted images (Fig. 75D).

Diagnosis

Hematocolpos, hematosalpinx, a double vagina with obstruction, and uterus didelphys

Differential Diagnosis

Dilated rectum (A normal rectum is seen posterior to the double vagina on the axial images; rectal contents have intermediate to low signal on T1 sequences.)
Large ovarian cyst (would not extend so inferiorly posterior to the bladder, nor would a midline septation be typical)
Massively dilated ureters (should have similar signal as urine in the bladder)