A haematometrium refers to retention of blood into the endometrial cavity due to obstruction at the level of the uterus, cervix, or vagina.
Primary haematometrium occurs in young women, usually due to congenital anomalies such as an imperforate hymen or a non-communicating Müllerian duct. Secondary haematometrium is rare and occurs in older women, usually the obstruction is at the level of the cervix.
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Clinical picture
In young women, it usually presents with primary amenorrhea with distended abdomen and lower abdominal pain.
In older women, it should be suspected in cases with secondary amenorrhea with lower abdominal pain.
Radiographic features
Ultrasound
Ultrasound is the first imaging modality for diagnosis, the endometrial cavity is distended with turbid fluid material of low-level echoes till the level of obstruction and stretched myometrium.
MRI
MRI is important to confirm the diagnosis, assess uterine anatomy and level of obstruction. It also provides information of other associated changes like hematosalpinx. The retained fluid vary in appearance on T2WI as it may show levelling and different intensities according to the age of the retained blood.
Differential diagnosis
- pyometrium: uterus filled with pus
- hematometrocolpos: uterus and vagina filled with blood
- hydrometrium: uterus filled with fluid