PMC5946351_01
A 16-year-old-female presented with severe right lower quadrant and right lower pelvic pain. Supine abdominal radiograph showing paucity of bowel loops in the right lower quadrant, with associated displacement of the small and large bowel loops superiorly.
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Abdominal radiograph showed superior displacement of bowel loops (Figure 1).
Transabdominal ultrasound. Midsagittal image of pelvis demonstrates (a) distended endometrial and endocervical cavities filled with complex fluid with low level internal echoes (*), compatible with hematometra and hematocolpos. Left horn of uterus was not appreciated on ultrasound, likely due to compression. Longitudinal image through the right flank (b) demonstrates nonvisualization of the right kidney.
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Transabdominal pelvic ultrasound distended endometrial and endocervical cavities filled with complex fluid with low level internal echoes:a provisional diagnosis of hematometra with hematocolpos was made (Figure 2). Additionally, the right kidney was absent (Figure 2).
Magnetic resonance imaging of pelvis demonstrates uterus didelphys with unilateral cervical atresia just above the external-os/noncommunicating cervix. Coronal T2WI with fat saturation (a) demonstrates unilateral (right) cervical atresia resulting in moderately distended cervix filled with T2 intermediate hyperintense fluid suggestive of blood (*). Axial fat sat T2WI (b) demonstrates blood filled distended lower uterine segment and cervix (*). The left horn of uterus didelphys is compressed by distended right horn (green arrows). UB, urinary bladder; FF, free fluid in cul-de-sac.
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MRI pelvis demonstrated uterus didelphys, right cervical atresia resulting in distended right endometrial and right endocervical cavities, and a compressed left uterine horn (Figure 3).