Ultrasound diagnosis of hydrocolpos: Prenatal findings and postnatal follow‐up

Mirk, Paoletta; Pintus, Claudio; Speca, Stefania

doi:10.1002/jcu.1870220112

Cited by 17 publications

(6 citation statements)

References 21 publications

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“…One difficulty in diagnosing pelvic masses is the potential confusion of the bladder with the hydrocolpos when the bladder is either empty or compressed by the mass18. The fetal bladder was clearly identified in our cases; it was in a midline position relative to the fetal pelvis, marked by the umbilical arteries, and its volume changed with time.…”

Section: Discussionmentioning

confidence: 74%

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

Picone

Laperelle

Sonigo

et al. 2007

Ultrasound in Obstet & Gyne

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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

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Section: Discussionmentioning

confidence: 74%

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

Picone

Laperelle

Sonigo

et al. 2007

Ultrasound in Obstet & Gyne

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“…The prenatal differentiation of female urogenital anomalies can be difficult because of their rarity, variations in presentation and poor imaging by ultrasonography, especially in late gestation. Although a prenatal diagnosis of hydrometrocolpos has been reported as early as 25 weeks of gestation4, most cases are described in the third trimester of pregnancy or after birth5–7. A large cystic abdominal mass could be detected at 35 weeks' gestation before referral of the patient to our institute.…”

Section: Discussionmentioning

confidence: 90%

Prenatal diagnosis of fetal hydrometrocolpos secondary to a cloacal anomaly by magnetic resonance imaging

Hayashi

Sago

Kashima

et al. 2005

Ultrasound in Obstet & Gyne

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CASE REPORTA 34-year-old woman, gravida 3 para 0, was referred to our institute at 37 weeks' gestation for evaluation of a fetal abdominal cystic mass. She had conceived by intrauterine insemination with ovulation induction after three spontaneous miscarriages. Because of her history, low-dose aspirin (81 mg/day) was administered in the current pregnancy up to 36 weeks' gestation. A routine fetal ultrasound examination in the second trimester showed no abnormal findings, but at 35 weeks of gestation a cystic mass was detected in the fetal abdomen. Detailed ultrasonography at referral revealed a retrovesical septate hypoechogenic mass measuring 77 × 76 × 73 mm within the fetal abdomen (Figure 1). Bilateral mild hydronephrosis was present, but there was no ascites. Cardiac anatomy and the extremities were normal. It was not possible to visualize the fetal external genitalia by ultrasound due to the late gestation and the sonographic findings were inconclusive. Magnetic resonance imaging (MRI) was then used to perform a detailed evaluation of the fetal abdominal mass. MRI confirmed that the abdominal mass was located in the midline posterior to the bladder and showed that it was connected to the dilated uterine cavity (Figure 2a). The mass was fluid-filled with a mid-plane septum (Figure 2b). A four-chamber appearance consisting of the septate mass and two small uterine cavities was observed (Figure 2c). These findings were consistent with a diagnosis of hydrometrocolpos with septate vagina and uterus didelphys. The rectum was not clearly visible in the T1-weighted image in which the presence of meconium appeared as hyperintense signals (Figure 2d). Although the cystic lesion was large and occupied the fetal abdomen, pulmonary hypoplasia was not observed on MRI.At 38 weeks' gestation a Cesarean section was performed due to the arrest of labor during induction with oxytocin. A female infant weighing 2438 g and with a length of 44 cm, and Apgar scores of 8 and 8 after 1 and 5 min, respectively, was delivered. Physical examination revealed abdominal distension, ambiguous genitalia and anal atresia. However, the face, limbs and digits were normal. There was a single perineal opening through which a urethral catheter was introduced, but

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“…13,14 Complete obstruction of the fetal vagina or uterus causes marked distention of the uterus, which appears as a cystic pelvic mass with septa or debris within it. In most cases, however, the mass is associated with other genitourinary tract abnormalities, such as cloacal malformations, severe obstruction of the urinary tract, and even renal agenesis.…”

Section: Ifferential D Iagnosismentioning

confidence: 99%

“…In most cases, however, the mass is associated with other genitourinary tract abnormalities, such as cloacal malformations, severe obstruction of the urinary tract, and even renal agenesis. 13,14 There are two types of hydrometrocolpos: the urinary type, which is associated with urogenital cloacal abnormalities, and the secretory type, which is due to an obstruction of the vaginal outlet and results in distention of the vagina and uterus by secretions of the endocervical gland. 14 In many cases a hydrometrocolpos is due to an isolated vaginal obstruction caused by vaginal atresia or an imperforate anus.…”

Section: Ifferential D Iagnosismentioning

confidence: 99%

Case 6-1995

Benacerraf¹,

Eichhorn²

1995

N Engl J Med

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A one-month-old girl was admitted to the hospital because of an intraabdominal mass.After a 42-week gestation, the infant had been delivered by cesarean section because of cephalopelvic disproportion. There were no complications during the pregnancy or delivery. A routine ultrasonographic examination ( Fig. 1), performed during the 28th week of pregnancy, showed a multiseptated cystic mass in the midabdomen. An ultrasonographic study during the 29th week of pregnancy showed the same mass slightly to the left of the midline. Another prenatal ultrasonographic examination at 30 weeks also showed the cystic abdominal mass near the midline. The infant weighed 3.76 kg at birth. She was fed a commercial formula with iron and was healthy from birth, although her parents described her as "colicky." Occasional constipation was noted; she did not vomit. Thirteen days before admission a computed tomographic (CT) scan of the abdomen (Fig. 2) revealed a cystic mass, 5 by 5 cm, that displaced the bowel to the left side and appeared to be unrelated to the genitourinary system or the liver. She was admitted to the hospital.The heart rate was 160, and the respirations were 24. The weight was 4.15 kg.On physical examination the infant appeared well. The head was normal, and the neck was supple. The lungs and heart were normal. The abdominal examination was normal; no organs or mass was felt. The external genitalia were normal, and rectal examination disclosed no pelvic or sacral mass. The neurologic examination was normal.The hematocrit was 34.9 percent, the white-cell count 13,200 per cubic millimeter, and the platelet count 505,000 per cubic millimeter. The mean corpuscular volume was 84 m m 3 .A diagnostic procedure was performed.

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Ultrasound diagnosis of hydrocolpos: Prenatal findings and postnatal follow‐up

Cited by 17 publications

References 21 publications

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

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

Prenatal diagnosis of fetal hydrometrocolpos secondary to a cloacal anomaly by magnetic resonance imaging

Case 6-1995

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