Presentation
Workup for recurrent urinary tract infections with dysuria and abdominal pain.
Patient Data
The voiding cystourethrogram (VCU) appears normal except for the small volume of residual contrast within the bladder post-micturition.
There is no vesicovaginal or urethrovaginal fistula present.
There is no vesicoureteric or vesicovaginal reflux demonstrated during the VCU.
The dual phasic (pre-contrast and mixed-phase) CT scan of the abdomen and pelvis is unremarkable except for the presence of contrast within the vagina, introitus, and diaper.
The renal tracts are normal, with no duplex systems and no ectopic ureters.
Modified and zoomed CT sagittal and coronal reformats confirming normal distal ureteric trajectories and normal bladder insertions.
Annotations:
Case Discussion
A suspected case of vesicovaginal reflux was demonstrated by the presence of contrast within the vagina, introitus, and including the child's diaper during axial CT imaging.
An ultrasound was initially performed for recurrent urinary tract infections. This was normal with the noted absence of any vaginal fluid/cystic lesion and specifically the absence of hydrocolpos or urocolpos.
After a formal urological assessment, a VCU was requested. The VCU was performed utilizing a combination of exposures and screen grabs to reduce the radiation dose. The VCU was normal except for a mild residual contrast within the bladder post-micturion.
Although the VCU did not demonstrate vesicovaginal reflux, this was the most plausible explanation for the CT findings in the absence of a vesicovaginal or urethrovaginal fistula.
CT also excluded the presence of ectopic ureters inserting into the vagina, and the history is also not suggestive of a continuous dribble to suggest ectopic ureters or vesicovaginal/urethrovaginal fistula.
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