Hydrometrocolpos

  • Etiology: Imperforate hymen or vaginal atresia or vaginal stenosis causing fluid accumulation in vagina and uterus
  • Terminology:
    — Metra = uterus and Colpos = vagina
    — Hydrometra = distension of the uterus with fluid
    — Hydrocolpos = distention of vagina with fluid
    — Hydrometrocolpos = distension of uterus and vagina with fluid
    — Hematometra = distension of the uterus with blood
    — Hematocolpos = distention of vagina with blood
    — Hematometrocolpos = distension of uterus and vagina with blood
  • Imaging:
    — Prerectal or rectovesical cystic mass with thick wall
    — Can have fluid-fluid level
    — Represents fluid in vagina and uterus and fallopian tubes
    — Can see urinary outflow obstruction
  • DDX:
  • Complications:
    — Due to mass effect – bladder outlet obstruction as dilated vagina can compress the urethra as it passes posterior to the pubic symphysis leading to hydronephrosis and infection
    — Due to mass effect – constipation
    –Ascites due to retrograde drainage of fluid through fallopian tubes
  • Treatment: Surgical
  • Clinical:
    — Presents in neonate as abdominal mass or in adolescent (more commonly) as abdominal pain and delayed onset of menses
    — For a cystic pelvic mass in a girl with primary amenorrhea think hydrometrocolpos

Radiology Cases of Hydrometrocolpos

Radiology Cases of Hematocolpos

US of hematocolpos
Transverse (above) and sagittal (below) US of the pelvis shows a large cystic structure filled with complex fluid posterior to the bladder which is visible on the right side of the sagittal image. The uterus was identified and was unremarkable and therefore the cystic structure was felt to represent a distended vagina.
US of hematocolpos
Sagittal US of the pelvis (above) shows the uterus (upper left) to have a pubertal appearance and to have no fluid within it while the vagina (to the right) is massively distended with heterogeneous appearing fluid. Transverse US of the pelvis better shows the complex nature of the fluid in the vagina.

Clinical Cases of Hydrometrocolpos

Clinical image of hydrometrocolpos
Clinical image shows a large tan mass protruding from the vagina. Ultrasound of the mass showed it to be distended with fluid and in continuity with the uterus and vagina.