*Newborn full term female with a distended abdomen and respiratory distress.
What is the most likely diagnosis?
1. Ovarian tumour
2. Abscess
3. Haematometrocolpos
4. Hydrometrocolpos
Answer
Answer: Hydrometrocolpos
Case Discussion:
MRI sections of hydrometrocolpos with an imperforate hymen. MRI sections show cystic mass in pelvis extending up to perineum and upper abdomen, fluid level in distended vagina, communication between distended vagina and uterus, bladder compressed by distended vagina.There are also bilateral hydronephrosis.
Hydrometrocolpos is a rare congenital disorder. It is characterized by an expanded fluid filled vaginal and uterine cavity caused by obstruction of the distal genital tract. It is the third most common cause of all abdominal masses in the newborn, accounting for 15% of all abdominal masses in female newborns. It can present at birth as a palpable mass or it can present at puberty as progressive accumulation of menstrual blood, causing haematometrocolpos. Vaginal obstruction can be caused by a high vaginal septum, vaginal atresia, cloacal malformations, or an imperforate hymen (1).
References:
1. Nalaboff KM, Pellerito JS, Ben-levi E. Imaging the endometrium: disease and normal variants. Radiographics. 21 (6): 1409-24.