MedPix® Patient Chart - Case No: 13387 :: - Review Images

12 y.o. girl with several days of decreased urine output, dysuria, and LLQ abdominal pain. No history of sexual activity and no history of menarche.

Fullness in lower abdomen with associated tenderness to palpation. Urinalysis with nitrites otherwise within normal limits.

- Review Images for PT: 13387

• Renal US normal
• Fluid collection in the pelvis, most consistent with hydrocolpos.
• No evidence of hydrometros.

- Review Images for PT: 13387

• UTI
• constipation
• obstructive uropathy
• pregnancy
• pelvic tumor
• ovarian cyst
• hydrocolpos, hydrometrocolpos

- Review Images for PT: 13387

Dx: Hydrocolpos secondary to imperforate hymen

Dx Confirmed by: pelvic US and pelvic exam

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Surgical hymenectomy with evacuation of 500cc of blood. Follow-up US obtained revealed resolution of hydrocolpos.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466100/pdf/annsurg00852-0082.pdf

Hydrocolpos is defined as accumulation of mucus or nonsanguineous fluid in the vagina. Hydrometrocolpos occurs when this material accumulates in the uterus as well. Isolated accumulation in uterus without accumulation in vagina is termed hydrometra.

Key points:
1. Imperforate hymen is the most common anatomic disorder during the pubertal period.
2. Clinical presentation:
• Adolescent female with complaints of vague abdominal pain
• May also present with constipation, urinary retention, and/or back pain
• May be identified in the neonatal period
• Occasionally complain of monthly exacerbations
• History of primary amenorrhea
• Secondary sexual characteristics developed normally
3. Physical exam findings:
• Tenderness and fullness midline on palpation of lower abdomen
• Pelvic exam often revealing bulging of hymen
• Color of hymen commonly described as bluish
4. Radiologic findings:
• Plain films may reveal a midline, lower abdominal mass
• On ultrasound, hydrocolpos appears as echogenic dilation of the vagina
-Tubular midline mass arriving from pelvis
-Mass is cystic appearing
-Echoes scattered (suggesting cellular debris, mucoid material or blood)
-Anatomy of kidneys and uterus also examined for dilation
• MRI with cross-sectional imaging may help identify origin of mass
5. Treatment: Surgery intervention necessary to create patent hymen

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