Fetal magnetic resonance imaging in the antenatal diagnosis and management of hydrocolpos

Abstract

Hydrocolpos should be considered systematically when an abdominopelvic cystic mass is diagnosed in a female fetus. Because the prognosis and neonatal management of isolated hydrocolpos with spontaneous resolution differs greatly from that of hydrocolpos associated with a cloacal CASE REPORTS Case 1A 37-year-old woman with three previous normal pregnancies underwent ultrasound examination at 33 weeks' gestation. An anechoic pelvic mass of 10 × 6 × 5 cm behind the fetal bladder was seen (Figure 1a). Further examination revealed pyelectasis of the left kidney (12-mm dilatation of the renal pelvis), right kidney agenesis and a single umbilical artery. Magnetic resonance imaging (MRI) was performed at 34 weeks. T1-weighted (TORSO coil; field of view (FOV) 36 × 36; 5.0 ThK/2.5 sp; FSE TR 8000 TE 125) and T2-weighted (TORSO coil; FOV 42 × 42; 5.0 thK/0.5 sp; FSPGR/60TR 150 TE min) sequences were obtained on a Sygma 1.5-T SYS-GEMS unit, in the frontal, coronal and sagittal planes. A cystic mass between the bladder and rectum was identified, which appeared hyperintense on T2 sequences and hypointense on T1 sequences. Visualization of a fluid-filled uterus above the mass (Figure 1b) led to the diagnosis of hydrometrocolpos. Pyelectasis was thought to have resulted from compression by the cystic mass. Cloacal malformations were ruled out because the T1 sequence showed normal intrarectal meconium and neither digestive dilatation nor enterolithiasis. At 36 weeks, worsening pyelectasis prompted us to deliver the 2600-g girl by Cesarean section. She was transferred to a pediatric surgery center and the hydrocolpos resolved spontaneously on the day after delivery. Ultrasound examination revealed heterogeneous mostly fluid materials in the pelvic collection, and moderate pyelectasis of the left kidney that disappeared on day 2. The final diagnosis was hydrometrocolpos due to an imperforate hymen, and it evacuated spontaneously after birth. The infant underwent surgical intervention at 2 months of age for an ovarian hernia. Vaginoscopy at that time showed a normal vagina and a single uterine cervix, but the hymen opening was very small and difficult to see. Uterine malformation (the incidence of which is known to be increased in women with renal agenesis) could not be ruled out. Case 2A 30-year-old woman in her first pregnancy was diagnosed with polyhydramnios at 27 weeks. No fetal abnormalities were observed, diabetes mellitus was ruled

Prenatal pelvic MRI: Additional clues for assessment of urogenital obstructive anomalies

“…Moreover, the same findings were seen in all the patients with cloacal malformation associated with hydrocolpos in our series. A large review of recent case reports disclosing good-quality images of either cloacal malformation with hydrocolpos [12,14e17] and urogenital sinus [18] or imperforate hymen [9] confirmed the findings of our study, except in one case of suspected imperforate hymen for which the final diagnosis was not clear according to the authors [7]. Our study adds to this literature a diagnosis algorithm (Fig.…”

Fetal hydrometrocolpos and congenital imperforate hymen: Prenatal and postnatal imaging features

“…4 Vaginal obstruction and accumulation of fluid in the genital tract leads to distension of the vagina and uterus. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] There is a pear-shaped cystic mass with fluid-debris level between the bladder and the rectum. 5 In the reported cases of hydrometrocolpos secondary to isolated congenital imperforate hymen, the prenatal US findings have been well described.…”

Pre‐ and postnatal findings in a boy with duplication of the bladder and intestine: Report and review

“…The utility of fetal MRI in cerebral anomalies has been well demonstrated; however, it's utility in other anomalies less clearly so. This case demonstrates the utility of fetal MRI in abdominal pathologies, in particular the use of T1‐weighted imaging to delineate the pattern of meconium within the colon, which has been demonstrated to follow a normal distribution by certain gestational ages, and variation from which should prompt raised suspicion for gastrointestinal and/or genitourinary tract pathology [Saguintaah et al, 2002; Veyrac et al, 2004; Farhataziz et al, 2005; Zizka et al, 2006; Inaoka et al, 2007; Picone et al, 2007].…”