Presentation
Amenorrhoea and cyclic lower abdominal pain.
Patient Data
Distended fluid-filled vagina with hyperechoic fluid with low-level echoes reflecting haematocolpos.
Left adnexal cystic structure is noted.
Markedly distended vagina with fluid content of high signal intensity on T1 that is accentuated on fat suppression, and low signal intensity on T2 in keeping with blood products (haematocolpos). The level of obstruction is in the lowermost part of the vagina likely due to imperforate hymen. The distended vagina is compressing the urinary bladder anteriorly and the rectum posteriorly.
The uterus is pushed superiorly and to the left. Minimal extension to endocervical canal is noted.
Dilated left fallopian tube with high signal intensity on T1 and low signal intensity on T2 in keeping with blood products (haematosalpinx).
Case Discussion
Imaging findings of marked haematocolpos extending down to the level of the hymen, in keeping with imperforate hymen. This is associated with left haematosalpinx which may be due to retrograde menstruation reaching fallopian tubes.
Imperforate hymen classically presents at the age of menarche with primary amenorrhoea and cyclic lower abdominal pain. It is not a Müllerian duct anomaly. It is treated surgically by simple incision or U-shaped excision.
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