Vaginal Anomalies

Overview of Congenital Anomalies in OB-GYN Ultrasound

  • Presenter: Sean Lysak

  • Focus: Congenital anomalies, ultrasound findings in genital defects.

  • Reference Material: Textbooks related to the subject.

Terminology

  • **Prefixes:

    • hydro**: refers to water

    • hemato**: refers to blood

    • muco**: refers to mucus

    • pyo**: refers to pus

  • Suffixes:

    • colpos: refers to the vagina

    • metra: refers to the uterus

    • salpingx: refers to the fallopian tubes

  • Example Terminology:

    • Hematometrocolpos: Accumulation of blood in uterus and vagina

    • Breakdown of the word:

      • hemato = blood

      • metra = uterus

      • colpos = vagina

Anatomy of the Female Reproductive Tract

  • Formation of the Vagina:

    • Upper one-third to two-thirds formed from Müllerian ducts.

    • Lower portion formed from urogenital sinus.

  • Müllerian Duct Contribution:

    • Structures from the two Müllerian ducts fuse, forming the uterus, and separate to form the fallopian tubes.

    • Area formed from Müllerian ducts is represented in blue on anatomical diagrams.

  • Gartner Duct Cysts:

    • Arising from the Wolffian duct, can be found near or in the vaginal wall, lateral to the cervix and uterus.

    • Remnants of the Wolffian duct may lead to cyst formation in the vagina.

  • Hydatid Cysts of Morgagni:

    • Formed from remnants of the Müllerian duct, located near the fallopian tubes and ovaries.

Vaginal Septum

  • Definition:

    • Rare anomaly, can be longitudinal or transverse.

  • Müllerian Origin:

    • Causes a double vagina in cases like uterus didelphys.

    • Septum usually limited to cranial vagina, typically does not reach external genitalia.

  • Variations of Septa Types:

    • Longitudinal Septum:

    • Open (both sides open to a common vaginal cavity)

    • Closed (blocks one side of the vagina)

    • Transverse Septum:

    • Separates the vagina into cranial and caudal sinuses; can cause hematocolpos and primary amenorrhea if it obstructs menstrual flow.

  • Clinical Implications:

    • Septa's association with conditions like uterus didelphys, bicornuate uterus, and septate uterus.

  • Example Cases:

    • Patient with a bicornuate and bicollis uterus and findings of hematocolpos due to obstruction in the vagina.

    • Imaging shows fluid collection in one side of the vagina indicating possible septum.

Imperforate Hymen

  • Definition:

    • A congenital urogenital sinus defect, resulting in the hymen being closed without an orifice.

  • Development of the Hymen:

    • Normally allows menstrual blood to pass; in an imperforate hymen, a membrane obstructs this pathway leading to primary amenorrhea.

  • Clinical Presentation:

    • Adolescent experiencing cyclic pelvic pain without actual menstruation, often leading to abdominal distension due to blood build-up (hematocolpos).

  • Ultrasound Characteristics:

    • Fluid collection in the vagina without an observable opening for a hymen.

    • Not able to perform transvaginal examinations as the hymen blocks entrance.

  • Treatment:

    • Incision into the hymen (cruciate incision) to allow for draining of accumulated blood.

Vaginal Agenesis and Related Conditions

  • Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH):

    • Characterized by vaginal agenesis and possible absence or hypoplasia of the uterus.

  • Clinical Characteristics:

    • Patients present with normal external genitalia and ovaries but lack a functional uterus and vaginal canal.

Embryonic Remnants and Cysts

  • **Hydatid Cysts of Morgagni:

    • Form from Müllerian duct remnants; often asymptomatic, found adjacent to the ovaries and fallopian tubes.**

  • Gartner Duct Cysts:

    • Arise from Wolffian duct remnants, located laterally to the cervix or within the vaginal wall, may require differential diagnosis from other cysts.

  • Sonographic Characteristics:

    • Cysts appear small, unilocular, typically found in vaginal walls but not mistaken for Nabothian cysts.

Conclusion

  • Congenital anomalies like vaginal septa, imperforate hymen, and agenesis have significant implications for patient management and understanding of the female reproductive anatomy. Understanding the ultrasound findings linked with these conditions is crucial for effective diagnosis and treatment.