Radiological particularities of the obstructive vaginal anomalies

Abstract

Introduction: Obstructive vaginal anomalies (OVA) are a very rare pathology, occurring at a frequency of 0.1% of newborn girls. OVA is a broad spectrum of various Müllerian anomalies: imperforate hymen (IH), complete transverse vaginal septum (CTVS), Herlyn-Werner-Wunderlich syndrome (HWW). Objective of the study: Evaluation of radiological features of obstructive vaginal anomalies by ultrasound examination (USG), computed tomography (CT) and magnetic resonance imaging (MRI). Material and methods: The retrospective and prospective study included 52 patients operated in the Department of Surgical Gynecology of the Institute of Mother and Child. The mean age was 15.7±0.3 years (95% CI: 14.97–16.34). Diagnosis confirmed by the USG exam (n=52,100%), CT (n=4, 7,7%) and MRI (n=7, 13,4%). Results: In all cases (100%) USG (transabdominal or transrectal) were performed. IH was detected in 29 (55.8%) cases, USG demonstrates hypoecogenic hematometrocolpos, MRI in T1W images - important uterine dilatation, intrauterine and intravaginal hemorrhagic fluid with hyperextension up to hymen; in T2W images – hyposemnal of intrauterine hemorrhagic content. CTVS was present in 8 (15.4%) cases, CT – intrauterine hyperdensus content with density up to 55UH; MRI demonstrates a vaginal transverse membrane appreciates its thickness and location. HWW syndrome was diagnosed in 15 (28.8%) patients and included uterus didelphys, obstructive hemivagina and ipsilateral renal agenesis. USG reveals renal agenesis and compensatory renal hypertrophy, the uterus didelphys with hypoecogenic fluid in the hemiuterus suggestive for haematometra, hematosalpinx. Based on the imaging data, the mean volume of the hematocolpos was 923.6±79.1 ml (95% CI:764.8–1082). Hematometra was detected in 23(44%) patients, hematosalpinx and pelvic endometriosis – 3(5.7%). Based on radiological findings (USG, TC and MRI), the maximal size of hematocolpos was 112.4±5.8 mm (95% CI:100.6–124.2), the minimal size was 76.7±3.5 mm (95% CI:69.64–83.81). In 16(30.7%) cases vaginal malformations were combined with renal anomalies. Conclusions: Modern imaging techniques elucidate the particularities of the radiological anatomy of OVA, allow early diagnosis of this pathology, treatment management to restore menstrual and fertile function.