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Hematometrocolpos - lower vaginal atresia

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Pelvic pain.

Patient Data

Age: 13 years
Gender: Female

Blood-filled distended uterus and upper vagina of high signal on T1WI, and low signal on T2WI with no visualization of the lower vaginal portion (even on thin cuts axial CUBE T2), indicating most likely vaginal atresia. Both ovaries are well-visualized containing small follicles.

Both kidneys are normally situated in the lumbar fossa with normal shape and size.

Case Discussion

In this case:

  • the upper vagina is more distended than the uterus
  • the uterus appears normal with no Müllerian duct anomalies
  • both kidneys are normally situated with no congenital anomalies

These findings indicate most likely an isolated lower vaginal atresia, not considered as a type of Müllerian duct anomaly. It occurs from a failure of recanalization of the urogenital sinus.

 

Additional contributors: R. Bouguelaa  MD, C. Boukaaba MD

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