PMC3375070_01
Pelvic US. (a) Transverse view shows a large well-defined cystic mass with internal echoes, which could easily be misinterpreted as overly distended urinary bladder. Note the bilateral ureteral dilatation. (b) Insertion of a Foley catheter makes it clear that the cystic mass is separate from the urinary bladder which is severely compressed and therefore hard to detect on ultrasound.
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fig1
The cyst reached up to the umbilical level (Figure 1(a)). No bladder could be identified on control pelvic ultrasonography (US) exams until the exam was repeated after the insertion of a Foley urethral catheter (Figure 1(b)).
Sagittal-T2-weighted MR image. Marked distention of the uterus and cervix is demonstrated. Note the compressed urinary bladder with little urine in it.
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fig2
The urinary bladder was significantly compressed (Figure 2).
Preoperative VCUG. Image reveals no reflux but a urinary bladder which could not receive appropriate amount of contrast material due to severe compression secondary to hematocolpos.
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fig3
The patient underwent voiding cystourethrogram (VCUG) which demonstrated no reflux but a compressed urinary bladder with a diminished urine volume of approximately 25cc (Figure 3).
T1-weighed postoperative MR images. (a) and (b): two consecutive pelvic coronal images clearly show the two cavities (arrows) of the uterus separated by an incomplete longitudinal septum which was difficult to depict earlier. (c) axial view through corpus shows bicornuate uterus.
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fig4
The suspicion of bicornuate uterus raised by pelvic control ultrasound was verified by a postoperative MR exam (Figures 4(a), 4(b), and 4(c)).