Persistent cloaca with hydrometrocolpos

This case is very similar to one of myour previous casecases here :https://radiopaedia.org/cases/persistent-cloaca-with-hydrometrocolpos-and-ascites-1?lang=gbExcept:-Oddly-oddly there was an atypical cystic pelvic image on first trimester US, which was non specific. Some may believe it does represent a communication between the bladder and the bowel (Prof. R. Chaoui).-Maternal-maternal overweight really limited US examination, thus the anal muscle hypoechoic ring could not be assessed. -there was no fetal ascites.-the uterine septum was partial.The combination of an hydrometrocolpos, an anorectal malformation and bilateral ureter & kidney pelvis dilation in a female fetus was very suggestive of a persistent cloaca.The diagnosis was confirmed at birth : distended abdomen and pelvis with an imperforate anus were seen. Upon surgery, the large bowel was connected to the uterus by an atretic cloacal channel. Anatomic repair is hardly doable in the neonatal period. Therefore, colostomy was performed, and drains were put in both bladder and uterus.For more information about cloaca, refer to the references below.Dr Fabrice Cuillier contributed to the US images, and of course the neonatal pediatric team and pediatric surgical team also contributed to this case.  

Unfortunately, our US scans displayed poor definition due to patient's overweight (over 110 kilograms).Macrocystic image in the pelvis of a female fetus, with internal echoic deposits. Ovarian cyst ? Unusual septum within the image: due to blood clot ? Other ?We quickly performed an MRI as soon as possible because we had numerous possible differentialsdifferential diagnoses in mind...

-The macrocystic image was located in the midline and extended way down into the pelvis towards the perineal area. It displayed an incomplete midline septum. Hypointense deposits are seen within. Its shape and location on the midline, behind the bladder are very suggestive of an hydrometrocolpos with a partial uterine septum.-The bladder was best seen on sagittal and axial view. It was pushed to the front by what appears to be an hydrometrocolpos, and was less than half-full. In contrast, there was dilation of both ureters and both kidney pelvis above the hydrometrocolpos. Either there was a mass effect on both ureters, either there was a low-urinary-tract-obstruction (LUTO) with "valve-effect" towards the colpos.-The meconium has a remarkable T1 hyperintense physiological signal, which is very handy to follow the large bowel. On axial, sagittal, and coronal view, no Hyperintense T1 meconium was seen in the pelvis. The large bowel likely ended 4 centimeters above the perineal skin: most likely a high-type anorectal malformation. There was no bowel dilation nor enterolithiasis.-Spine and spinal cord showed normal MRI appearance.