Presentation
Lower abdominal distension and pain
Patient Data
The vagina is seen elongated and distended with high signal intensity on T1 weighted images (WIs), low signal on T2 WIs and fat-saturated T1 images shows high signal (no signal suppression) indicating blood. The vagina is displacing the uterus upwards. The endometrial cavity shows a minimal amount of fluid, especially in its lower segment.
Case Discussion
Vertically elongated fluid-filled vaginal cavity with enhancing walls on contrast images (not available in this case) displacing the uterus, urinary bladder, and rectum. The endometrial cavity shows a minimal amount of fluid especially in the lower segment denoting hematometrocolpos most likely due to an imperforate hymen.
Causes of hematometrocolpos include:
- Imperforate hymen
- Transverse vaginal septum (mostly between the middle and upper thirds of the vagina)
- Vaginal stenosis or atresia
- Cervical stenosis or atresia
- Mass effect from duplications of the uterus or vagina
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