DOCSLIB.ORG

Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department Current Problems in Diagnostic Radiology 48 (2019) 473À481 Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department Karen Tran-Harding, MD*, James T. Lee, MD, Joseph Owen, MD Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY ABSTRACT Women commonly present to the emergency room with subacute or acute symptoms of gynecologic origin. Although a pelvic exam and ultrasound (US) are the pre- ferred initial diagnostic tools for gynecologic entities, a CT is often the first line imaging modality in the emergency department. We will provide a review of normal uterine enhancement and normal pregnancy related findings, and then familiarize radiologists with the CT appearances of gynecologic entities classically described on ultrasound that may present to the emergency department. © 2018 Elsevier Inc. All rights reserved. Introduction lower attenuation than myometrium, its thickness varies with the menstrual cycle, and it should not be mistakenly described as blood Pelvic pain is a common reason for women to present to the emer- or fluid in the canal (Fig 1 A/B open arrowhead). During the menstrual gency department. Detailed menstrual, sexual, and surgical history, and cycle, the endometrium can measure anywhere from 1 mm during screening beta-human chorionic gonadotropin (hCG), are essential to menstruation and up to 7-16 mm during the secretory phase.1 differentiate gynecologic pain from other etiologies. Ultrasonography is Four subtypes of myometrial enhancement have been the preferred modality for imaging of gynecologic disease, but in a busy described.2,3 Type 1 is a subendometrial band of enhancement that emergency room setting, computed tomography (CT), may be the initial may be thin or thick (Fig 1 A/B), with or without outer myometrial imaging modality used for women with incomplete history and nonspe- enhancement (Fig 1 C), 30-120 seconds after contrast injection.3 The cific complaints. Furthermore, CT is widely available, fast, and efficient type 1 pattern is seen mainly in premenopausal women.3 Type 2 is and can rule out other causes of pain. Although most radiologists are diffuse enhancement throughout the entire myometrium or enhance- familiar with common gynecologic entities with ultrasonographic imag- ment that progresses from the outer myometrium to the entire myo- ing, recognizing the CT appearance of gynecologic pathology is impor- metrium (Fig 1 D/E), without distinct subendometrial enhancement. tant. Unfortunately, in a very busy emergency department, it is often The type 2 pattern of enhancement is observed equally in pre and easy to overlook subtle abnormality in the female pelvis on CT, even postmenopausal women.3 Type 3 is no or minimal enhancement though, it can often reveal the source of pain or pathology when the rest throughout the myometrium (Fig 1 F). This type is seen in postmeno- of the study is normal. pausal women.3 Type 4 is a patchy, heterogeneous enhancement of the entire myometrium (Fig 1 G/H) and is less well described and less common than the other types.2 The Wide Spectrum of Normal The physiology underlying the wide range of normal enhance- ment patterns is not well understood. Menstrual status, patient age, Patterns of Uterine Enhancement and contrast timing are the most important factors.3 Given the vari- The appearances of the normal uterus vary greatly, especially after ability of myometrial enhancement, recognizing focal mass-like intravenous contrast. Familiarity with the spectrum of normal imag- enhancement, parametrial stranding, and uterine contour abnormal- ing patterns is important to avoid describing a variant of normal as ity are the key to diagnosing gynecologic infection or neoplasm. pathologic. When the uterus has an abnormal appearance on CT, an MRI or ultra- On noncontrast CT, the myometrium appears homogenous and sound is indicated for further characterization. isodense to skeletal muscle. The normal endometrial canal exhibits The vascular structures within the pelvis can also exhibit variabil- ity. Dilated uterine vessels (Fig 1 H) may be encountered incidentally Disclosure of potential conflicts of interest: Author A declares that he/she has no con- and are often seen in multiparous reproductive age women. The flict of interest. Author B declares that he/she has no conflict of interest. Author C increase vascularity associated with pregnancy may cause dilation of fl declares that he/she has no con ict of interest. venous structures in the pelvis and over time lead to incompetent *Reprint requests: Karen Tran-Harding, MD, Department of Diagnostic Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY. venous valves. Dilated uterine veins have been associated with a con- E-mail address: [email protected] (K. Tran-Harding). dition called pelvic venous congestion syndrome, and while the https://doi.org/10.1067/j.cpradiol.2018.07.009 0363-0188/© 2018 Elsevier Inc. All rights reserved. 474 K. Tran-Harding et al. / Current Problems in Diagnostic Radiology 48 (2019) 473À481 FIG 1. Wide range of normal uterine enhancement patterns are observed on contrast enhanced CT. (a) and (b) sagittal and axial CT images of different patients show normal thin (A) and thick (B) subendometrial enhancement (arrow). Also note the variable thickening of the normal hypoattenuating endometrial tissue (open arrowheads), not to be confused with fluid in the endometrial canal. (C) Axial CT image shows a normal retroverted uterus with both subendometrial enhancement (arrow) and outer myometrial (open arrow) enhance- ment. (D) and (E) axial and sagittal CT images of a normal uterus with diffuse myometrial enhancement (black arrows), (F) axial CT image shows minimal diffuse enhancement (asterisk) and dilated pelvic varices (black arrowheads). (G) and (H) Sagittal CT images of different patients show normal patchy heterogeneous enhancement of the myometrium (arrowheads). Note the relative hypoenhancement of the cervix compared to the uterus (brackets) on e and h. majority of women with dilated pelvic vessels are asymptomatic, it millimeters in diameter but may reach 4 cm or more.7 On CT, they may be helpful to raise the possibility of pelvic venous congestion solitary, scattered or clustered cysts, with a thin nonenhancing wall, syndrome in ED patients presenting with engorged pelvic veins.4 The and central fluid attenuation.2 diagnostic criteria for CT consists of at least 4 ipsilateral parauterine On CT, the vaginal mucosa of reproductive age women enhances. veins of varying caliber, with at least 1 measuring more than 4 mm The vaginal wall is may be inseparable from the urethra and rectal in diameter, or an ovarian vein diameter greater than 8 mm.4 wall and is hypoattenuating relative to the mucosa. In postmeno- pausal women, the vaginal mucosa appears similar to the vaginal wall and is hypoenhancing.8 Variability of the Cervix and Upper Vagina The normal cervix measures on average 3 cm and the width of the internal cervical os measures 3 mm.5 Cervical zonal enhancement is Foreign Bodies seen in patients with a type 1 or type 2 uterine enhancement pattern Foreign bodies related to menstruation, pelvic floor laxity, and (Fig 1 A).3 A target-like appearance of the cervix results from relative contraception are often seen incidentally on CT in the emergency hyper-enhancement of the central glandular mucosa and relative room setting. The most common vaginal foreign body is a tampon, hypo-enhancement of the outer fibromuscular stroma.3 The cervical which typically has the attenuation of air, secondary to gas trapped fibromuscular stroma demonstrates gradual enhancement that often between the tampon fibers (Fig 2 A). Occasionally patients will forget lags behind uterine myometrium (Fig 1 E/H).6 to remove a tampon, and it can serve a source of infection. A pessary Nabothian cysts are benign retention cysts resulting from chronic is a device placed into the vagina to prevent pelvic organ prolapse. inflammation on endocervical glands that should not be mistaken for They have variable appearance but most commonly appear as a thick pathology. Nabothin cysts can vary in size, ranging from a few ring of uniform high attenuation in the vagina. (Fig 2 B/C) A FIG 2. Foreign bodies are commonly encounter in the vagina. (A) sagittal CT image shows a mixed attenuation tubular tampon predominately composed of gas in the vagina (arrow- head). (B) and (C) axial and coronal CT images of different patients with pessary devices in the vagina (arrows). (D) sagittal CT image shows a rectangular hyperdense foreign body in the vagina which on physical exam was a piece of candy (open arrowhead). (E) sagittal CT image shows a urinary catheter inadvertently placed in the vagina (asterisk). K. Tran-Harding et al. / Current Problems in Diagnostic Radiology 48 (2019) 473À481 475 FIG 3. Intrauterine devices (IUD) and tubal occlusion devices (TOD) are frequently encountered on CT. (A) axial CT image of the pelvis shows a T-shaped IUD (arrow) in expected position with the 2 limbs extending toward the uterine cornua and the stem within the endometrial canal. (B) sagittal CT image of the pelvis shows an IUD extending from the cer- vix into the posterior myometrium (arrowhead) of the low uterine segment. (C) oblique sagittal CT image shows an IUD (arrow) which has migrated out of the uterus into the peri- toneal cavity. (D) axial CT image shows TOD (open arrow) extending from the cornua of the uterus along the expected course of the fallopian tubes. (E) sagittal CT image shows a TOD which has migrated out of the fallopian tube to an intraperitoneal location inferior to the uterus (open arrowhead). (F) axial CT image shows a TOD which has migrated anterior to the uterus (open arrowhead). contraceptive ring appears similar to a pessary, but is found in peritoneal cavity11 (Fig 3 C).
Load more

Recommended publications
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A
    Evaluation of the Uterine Causes of Female Infertility by Ultrasound: A Literature Review Shohreh Irani (PhD)1, 2, Firoozeh Ahmadi (MD)3, Maryam Javam (BSc)1* 1 BSc of Midwifery, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 2 Assistant Professor, Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran 3 Graduated, Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Iranian Academic Center for Education, Culture, and Research, Tehran, Iran A R T I C L E I N F O A B S T R A C T Article type: Background & aim: Various uterine disorders lead to infertility in women of Review article reproductive ages. This study was performed to describe the common uterine causes of infertility and sonographic evaluation of these causes for midwives. Article History: Methods: This literature review was conducted on the manuscripts published at such Received: 07-Nov-2015 databases as Elsevier, PubMed, Google Scholar, and SID as well as the original text books Accepted: 31-Jan-2017 between 1985 and 2015. The search was performed using the following keywords: infertility, uterus, ultrasound scan, transvaginal sonography, endometrial polyp, fibroma, Key words: leiomyoma, endometrial hyperplasia, intrauterine adhesion, Asherman’s syndrome, uterine Female infertility synechiae, adenomyosis, congenital uterine anomalies, and congenital uterine Menstrual cycle malformations. Ultrasound Results: A total of approximately 180 publications were retrieved from the Uterus respective databases out of which 44 articles were more related to our topic and studied as suitable references.
    [Show full text]
  • (IJCRI) Abdominal Menstruation
    www.edoriumjournals.com CASE SERIES PEER REVIEWED | OPEN ACCESS Abdominal menstruation: A dilemma for the gynecologist Seema Singhal, Sunesh Kumar, Yamini Kansal, Deepika Gupta, Mohit Joshi ABSTRACT Introduction: Menstrual fistulae are rare. They have been reported after pelvic inflammatory disease, pelvic radiation therapy, trauma, pelvic surgery, endometriosis, tuberculosis, gossypiboma, Crohn’s disease, sepsis, migration of intrauterine contraceptive device and other pelvic pathologies. We report two rare cases of menstrual fistula. Case Series: Case 1: A 27- year-old nulliparous female presented with complaint of cyclical bleeding from the abdomen since three years. There was previous history of hypomenorrhea and cyclical abdominal pain since menarche. There is history of laparotomy five years back and laparoscopy four years back in view of pelvic mass. Soon after she began to have blood mixed discharge from scar site which coincided with her menstruation. She was diagnosed to have a vertical fusion defect with communicating left hypoplastic horn and non-communicating right horn on imaging. Laparotomy with excision of fistula and removal of right hematosalpinx was done. Case 2: 25-year-old female presented with history of lower segment caesarean section (LSCS) and burst abdomen, underwent laparotomy and loop ileostomy. Thereafter patient developed cyclical bleeding from scar site. Laparotomy with excision of fistulous tract and closure of uterine rent was done. Conclusion: Clinical suspicion and imaging help to clinch the diagnosis. There is no recommended treatment modality. Surgery is the mainstay of management. Complete excision of fistulous tract is mandatory for good long-term outcomes. International Journal of Case Reports and Images (IJCRI) International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.
    [Show full text]
  • Successful Pregnancy Complicated by Adnexal Torsion After IVF in a 45
    Case Report iMedPub Journals Gynecology & Obstetrics Case Report 2016 http://www.imedpub.com/ Vol.2 No.2:27 ISSN 2471-8165 DOI: 10.21767/2471-8165.1000027 Successful Pregnancy Complicated by Adnexal Torsion after IVF in a 45-Year- Old Woman Cirillo F1, Zannoni E1, Scolaro V1, Mulazzani GEG3, Mrakic Sposta F2, De Cesare R1 and Levi-Setti PE1* 1Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Humanitas Fertility Center, EBCOG/ESHRE Subspecialty European Center in Reproductive Medicine, Humanitas Research Hospital, Rozzano (Milan), Italy 2Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy 3Department of Radiology, Division of Diagnostic Radiology, Humanitas Research Hospital, Rozzano (Milan), Italy *Corresponding author: Paolo Emanuele Levi-Setti, Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Humanitas Fertility Center, EBCOG/ESHRE Subspecialty European Center in Reproductive Medicine, Humanitas Research Hospital, Rozzano (Milan), Italy, Tel: 10125410158, E-mail: [email protected] Received date: 12 June, 2016; Accepted date: 26 August, 2016; Published date: 29 August, 2016 Citation: Cirillo F, Zannoni E, Scolaro V. Successful pregnancy complicated by adnexal torsion after IVF in a 45-year-old woman, Gynecol Obstet Case Rep. 2016, 2:2. Introduction Abstract Ovarian torsion occurs when the ovarian vascular pedicle performs a complete or partial rotation around its axis with Ovarian torsion accounts for 3% of gynecological consequent impairment in vascular supply [1]. emergencies. Its incidence is higher in all those cases of ovarian hypermobility and adnexal masses, such as Torsion is considered the 5th most common surgical Ovarian Hyperstimulation Syndrome (OHSS) as a emergency in women, accounting for more than 3% of all consequence of in vitro fertilization (IVF) treatments.
    [Show full text]
  • Ovarian Torsions and Other Gynecologic Emergencies
    Ovarian Torsions and Other Gynecologic Emergencies A Clinician’s Guide to Managing Ob/Gyn Emergencies World Health Special Focus on Haiti Ambereen Sleemi, MD,MPH No Disclosures Torsion and other gyn emergencies • Ovarian torsion • Gynecologic cancers • Cervical cancer • endometrial cancer • ovarian cancer Ovarian Torsion • What is ovarian torsion? • Why is is an emergency? • How is it treated? Ovarian Torsion • A twisting of the ovary around its support and cutting off of the blood supply • cutting off the blood supply causes severe abdominal pain and death of the tissue • treated as a surgical emergency Ovarian Torsion The blood supply to the ovary is cut off by the twisting of an enlarged, usually cystic ovary Ovarian Torsion • An ovarian torsion presents with classic findings of severe onset of intermittent abdominal pain, that may wax and wane (over 90%) • it may be associated with nausea and vomiting (over 80%) • 60% occur on right side • risk factors are pregnancy, reproductive age (can be pre or post menopausal also) Torsion and untwisted Signs and Symptoms • Vague complaints of lower abdominal pain • Classic- sitting or sleeping and sudden severe pain that disappears and reappears • Nausea and vomiting • Often a delay in diagnosis Findings • Unilateral adnexal mass or tumor usually seen • lower abdominal pain • Pelvic exam- palpate a unilateral, tender mass • Pregnancy associated with up to 20% of torsion cases • Ultrasound with adnexal mass, low or no blood flow Management • Pregnant or not, management same • Surgical treatment
    [Show full text]
  • Recurrent Hematometra with Endometriosis in an Adolescent Girl: a Case Report
    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Garg R et al. Int J Reprod Contracept Obstet Gynecol. 2019 Nov;8(11):4567-4569 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194895 Case Report Recurrent hematometra with endometriosis in an adolescent girl: a case report Sarita Agrawal, Rajshree Sahu*, Pushpawati Thakur, Vinita Singh, Pawan B. Chandramohan Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India Received: 18 August 2019 Revised: 19 September 2019 Accepted: 09 October 2019 *Correspondence: Dr. Rajshree Sahu, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Hematometra is a collection or retention of blood in the uterine cavity. This condition is most commonly associated with congenital uterine anomalies that result from abnormal formation, fusion or resorption of Mullerian ducts during fetal life or may be due to prior surgical procedures, causing an obstruction of the genitourinary outflow tract. We report an unusual case of hematometra with endometriosis secondary to cervical stenosis. This is a rare and important case report due to the complexity of diagnosis as cervical stenosis was not presented as primary amenorrhoea as its usual presentation. This case was successfully managed by Hysteroscopic cervical dilatation under USG guidance followed by transcervical insertion of a catheter to prevent recurrent stenosis.
    [Show full text]
  • Clinical Outcomes of Hysterectomy for Benign Diseases in the Female Genital Tract
    Original article eISSN 2384-0293 Yeungnam Univ J Med 2020;37(4):308-313 https://doi.org/10.12701/yujm.2020.00185 Clinical outcomes of hysterectomy for benign diseases in the female genital tract: 6 years’ experience in a single institute Hyo-Shin Kim1, Yu-Jin Koo2, Dae-Hyung Lee2 1Department of Obstetrics and Gynecology, Yeungnam University Hospital, Daegu, Korea 2Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea Received: March 17, 2020 Revised: April 7, 2020 Background: Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical Accepted: April 14, 2020 procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam Corresponding author: University Hospital. Yu-Jin Koo Methods: We retrospectively reviewed patients who underwent a hysterectomy for benign dis- Department of Obstetrics and eases from 2013 to 2018. Data included the patients’ demographic characteristics, surgical indi- Gynecology, Yeungnam University cations, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu Results: A total of 809 patients were included. The three major indications for hysterectomy were 42415, Korea uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was Tel: +82-53-620-3433 total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During Fax: +82-53-654-0676 the study period, the rate of open hysterectomy was nearly constant (29.4%–38.1%). The mean E-mail: [email protected] operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 min- utes).
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • Page Mackup January-14.Qxd
    Bangladesh Journal of Medical Science Vol. 13 No. 01 January’14 Case report: Unilateral Functional Uterine Horn with Non Functioning Rudimentary Horn and Cervico-Vaginal Agenesis: Case Report Hakim S1, Ahmad A2, Jain M3, Anees A4. ABSTRACT: Developmental anomalies involving Mullerian ducts are one of the most fascinating disorders in Gynaecology. The incidence rates vary widely and have been described between 0.1-3.5% in the general population. We report a case of a fifteen year old girl who presented with pri- mary amenorrhea and lower abdomen pain, with history of instrumentation about two months back. She was found to have abdominal lump of sixteen weeks size uterus. On examination vagina was found to be represented as a small blind pouch measuring 2-3cms in length. A rec- tovaginal fistula (2x2 cms) was also observed. Ultrasonography of abdomen revealed bulky uterus (size 11.2x6 cm) with 150 millilitre of collection. A diagnosis of hematometra with iatro- genic fistula was made. Vaginal drainage of hematometra was done which was followed by laparotomy. Peroperatively she was found to have a left side unicornuate uterus with right side small rudimentary horn. Left fallopian tube and ovary showed dense adhesions and multiple endometriotic implants. Both cervix and vagina were absent. Total abdominal hysterectomy was done and rectovaginal fistula repaired. The present case is reported due to its rarity as it involved both mullerian agenesis with cervical and vaginal agenesis along with disorder of lat- eral fusion. This is an asymmetric type of mullerian duct development in which arrest has occurred in different stages of development on two sides.
    [Show full text]
  • Uterine Cervix and Proximal Third of Vagina Agenesis with Functional Uterus: Case Report and Literature Review
    Endocrinologia Ginecológica ISSN 2595-0711 RELATO DE CASO Uterine cervix and proximal third of vagina agenesis with functional uterus: Case report and literature review Ana Luíza Fonseca Siqueira1, Marta Ribeiro Hentschke1, Martina Wagner1, Luiza Machado Kobe1, Charles Schneider Borges1, Vanessa Devens Trindade1, Marcelo Moretto1, Andrey Cechin Boeno1, Adriana Arent1 1Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas, Serviço de Ginecologia, Porto Alegre, RS, Brasil Abstract Objectives: We aimed to describe the case of a patient presenting cervix agenesis with presence of vagina and functioning uterus. Methods: A 19-year-old patient was referred to Human Reproduction service due to primary amenorrhea, cyclic pelvic pain, and dyspareunia. She was diagnosed with cervical and vaginal agenesis, and menstrual flow suppression was the chosen treatment. Results: Regarding treatment options, hysterectomy is the classic treatment; however, due to advances in minimally invasive surgery and reproductive medicine, procedures such as uterine-vaginal anastomosis have been proposed. Young patients with no current reproductive wish, may opt for hormonal suppression of the menstrual flow to minimize cyclical discomfort and prevent or treat possible foci of endometriosis. However, for those seeking pregnancy, techniques of assisted reproduction can be considered. The approach should always be individualized, considering the anatomical details, clinical aspects, and patient’s opinion. Conclusions: Management of cervical agenesis is a challenge due to the complexity of the malformation and the difficulty in restoring and preserving fertility. Lastly, report such rare conditions and its treatment options, seems to be beneficial to help other patients with similar conditions. Keywords: congenital abnormalities; mullerian ducts; assisted reproduction.
    [Show full text]
  • The Differential Diagnosis of Acute Pelvic Pain in Various Stages of The
    Osteopathic Family Physician (2011) 3, 112-119 The differential diagnosis of acute pelvic pain in various stages of the life cycle of women and adolescents: gynecological challenges for the family physician in an outpatient setting Maria F. Daly, DO, FACOFP From Jackson Memorial Hospital, Miami, FL. KEYWORDS: Acute pain is of sudden onset, intense, sharp or severe cramping. It may be described as local or diffuse, Acute pain; and if corrected takes a short course. It is often associated with nausea, emesis, diaphoresis, and anxiety. Acute pelvic pain; It may vary in intensity of expression by a woman’s cultural worldview of communicating as well as Nonpelvic pain; her history of physical, mental, and psychosocial painful experiences. The primary care physician must Differential diagnosis dissect in an orderly, precise, and rapid manner the true history from the patient experiencing pain, and proceed to diagnose and treat the acute symptoms of a possible life-threatening problem. © 2011 Elsevier Inc. All rights reserved. Introduction female’s presentation of acute pelvic pain with an enlarged bulky uterus may often be diagnosed as a leiomyoma in- Women at various ages and stages of their life cycle may stead of a neoplastic mass. A pregnant female, whose preg- present with different causes of acute pelvic pain. Estab- nancy is either known to her or unknown, presenting with lishing an accurate diagnosis from the multiple pathologies acute pelvic pain must be rapidly evaluated and treated to in the differential diagnosis of their specific pelvic pain may prevent a rapid downward cascading progression to mater- well be a challenge for the primary care physician.
    [Show full text]
  • Recently Discovered Interstitial Cell Population of Telocytes: Distinguishing Facts from Fiction Regarding Their Role in The
    medicina Review Recently Discovered Interstitial Cell Population of Telocytes: Distinguishing Facts from Fiction Regarding Their Role in the Pathogenesis of Diverse Diseases Called “Telocytopathies” Ivan Varga 1,*, Štefan Polák 1,Ján Kyseloviˇc 2, David Kachlík 3 , L’ubošDanišoviˇc 4 and Martin Klein 1 1 Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 813 72 Bratislava, Slovakia; [email protected] (Š.P.); [email protected] (M.K.) 2 Fifth Department of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava, 813 72 Bratislava, Slovakia; [email protected] 3 Institute of Anatomy, Second Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; [email protected] 4 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, 813 72 Bratislava, Slovakia; [email protected] * Correspondence: [email protected]; Tel.: +421-90119-547 Received: 4 December 2018; Accepted: 11 February 2019; Published: 18 February 2019 Abstract: In recent years, the interstitial cells telocytes, formerly known as interstitial Cajal-like cells, have been described in almost all organs of the human body. Although telocytes were previously thought to be localized predominantly in the organs of the digestive system, as of 2018 they have also been described in the lymphoid tissue, skin, respiratory system, urinary system, meninges and the organs of the male and female genital tracts. Since the time of eminent German pathologist Rudolf Virchow, we have known that many pathological processes originate directly from cellular changes. Even though telocytes are not widely accepted by all scientists as an individual and morphologically and functionally distinct cell population, several articles regarding telocytes have already been published in such prestigious journals as Nature and Annals of the New York Academy of Sciences.
    [Show full text]