Imperforate hymen

Case contributed by Ali Alsmair


The patient presented with gradually increasing lower abdominal distension, urinary urgency and incontinence and constipation. No significant pain.

Patient Data

Age: 10 years
Gender: Female

Cystic ballooning of the vagina is noted, measuring about 11 x 10 x 20 cm (AP.TRANS.CC), with hemorrhagic content appearing as slightly hyperintense on T1 and obviously hyperintense on T2.
No extension of the hemorrhagic content into the uterine cavity.
This cystic dilatation appears to be involving the whole vagina down to the hymen and causing significant compression on the urinary bladder anteriorly and the rectum posteriorly.
No evidence of vaginal septum could be seen.
No evidence of associated uterine or kidneys anomalies.  Both kidneys are located in their normal positions.

Features are consistent with hematocolpos secondary to imperforate hymen.
No evidence of vaginal septum.
No evidence of haematometrium.

Mild right-sided hydrosalpinx manifested as a small tubular structure with incomplete septa.

29 x 25 mm left ovarian follicular cyst is noted.

Minimal pelvic free fluid is noted. 


There is marked dilatation and expansion of the whole vagina which is filled with bloody content down to tho hymen (which is seen as a partially visualized transverse echogenic line inferiorly and obscured by the public bones acoustic shadow), without evidence of vaginal septa. 

Case Discussion

In the cases of hematocolpos and haematometrium, the possible causes such as imperforate hymen and transverse vaginal septum should be excluded. 

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