PMC3409925_01
(a) Axial trans abdominal USG image showing right (RH) and left (LH) uterine horns. A hypoechoic lesion (M) is seen caudally (b) Sagittal trans abdominal USG image showing endometrial cavity of the right uterine horn (RH) communicating with the hypoechoic lesion (M) (c) Sagittal USG image directed further caudally shows the hypoechoic lesion to be an ovoid fluid collection with internal echoes, located posterior to the urinary bladder. It appears to end slightly above the introitus
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F1
The right horn was seen to communicate caudally with a large, ovoid fluid collection with internal echoes [Figure 1a-c].
Trans labial sagittal USG image confirms that the collection (C) ends 1.5 cm above the introitus
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F2
Translabial ultrasound revealed the lower limit of pelvic fluid collection, which was seen to end 1.5 cm above introitus [Figure 2].
(a) Coronal Single shot T2W image shows absence of the right kidney. The distended hemivagina (asterisk) is seen on the right side and the normal collapsed left hemivagina with minimal fluid is seen adjacent to it (black arrow). The distended hemivagina ends above the introitus and its contents are hypointense to fat. (b) Coronal Single shot T2W image shows right and left uterine horns (white arrows). The right uterine horn cavity is seen to communicate with the upper end of the fluid collection in right hemivagina (small black arrow)
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F3
The upper end communicated with the right uterine horn through the right cervix [Figure 3a and b].
(a) Axial T1W image of the pelvis shows bright signal intensity of the right hemivaginal collection (asterisk). The collapsed left hemivagina is seen adjacent to it (arrow) (b) Axial fat saturated T2W image of the pelvis showing right hemivaginal collection (asterisk) and collapsed left hemivagina with minimal fluid (arrow)
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F4
Signal intensity of the contents of distended hemivagina was consistent with blood products, suggestive of a right hemato-hemicolpos [Figure 4a and b].
Diagrammatic representation of anatomy of patient showing OHVIRA syndrome
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F5
A diagrammatic representation of patient's anatomy makes it clearer [Figure 5].
(a) Intraoperative photograph showing smooth bulge (black arrow) in medial wall of patent left hemivagina caused by right hematohemicolpos (b) Intraoperative photograph of septoplasty procedure showing drainage of altered blood
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F6
Patient was relieved of her symptoms [Figure 6b].