Presentation
Primary amenorrhea and cyclic abdominal pain.
Patient Data
Cystic ballooning of the vagina showing internal fluid-fluid leveling content displaying mixed intermediate and high T1 and T2 signals with no signal drop in the T1 fat sat images (denoting hemorrhagic content).
Such dilatation is seen extending caudally to the level of symphysis pubis.
Associated mild bulging of the lower vagina at the level of the hymen.
No evidence of vaginal septum could be noted.
No manifest dilatation of the uterine cavity.
Small right adnexal cyst of fluid signal (low T1 and bright T2) is seen measuring about 1 x 0.7 cm.
Mild pelvic free fluid tendency to loculation.
Case Discussion
Primary amenorrhea with cyclic lower abdominal pain during menarche age. An imperforate hymen can be diagnosed at physical examination upon identification of a bulging, bluish membrane that allows positive transillumination at the introitus; consequently, imaging is rarely indicated.
It occurs due to failure of the recanalization process of the distal end of the vagina. The hymen indicates the junction between the urogenital sinus and sinovaginal bulb. Imperforate hymen occurs due to a failure of recanalization of this membranous vestige.
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