Case of the Month September 2017, Page 2

Ultrasound

Limited grayscale ultrasound images from OSH demonstrate a fluid-filled, vertically-oriented cystic structure in the pelvis posterior to the bladder, adjacent and possibly contiguous with the uterus, extending to the right lower quadrant. Echogenic material is seen layering within. A normal-appearing left ovary is visualized. There is moderate free fluid.

 A CT abdomen/pelvis with contrast was recommended for further evaluation. 

CT Abdomen/Pelvis

Contrast-enhanced axial and sagittal views of the abdomen and pelvis demonstrate an elongated fluid-filled cystic structure within the midline pelvis. The outside report described a “distended uterus with dilated endometrium, compatible with hydrometrocolpos.”

 

The clinical team noted a patent vaginal introitus on exam and felt that the clinical picture was not consistent with a hydro/hematometrocolpos. The decision was to proceed with a pelvic MRI. 

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