Diagnostic Ultrasound - Abdomen and Pelvis

Hematometrocolpos
Diagnoses: Female Pelvis
TERMINOLOGY
• Hematometrocolpos: Distension of uterus and vagina by
accumulated blood
IMAGING
• US best for initial evaluation or to confirm CT findings
○ HM appears thick-walled due to surrounding
myometrium
○ HC is lower in pelvis and appears thin-walled compared
to HM
○ Mixed echogenicity material within uterine &/or vaginal
cavities
○ No flow: Presence of flow should raise concern for mass
• MR best to confirm blood products, absence of solid mass
• MR best to clarify anatomy, relationship of pelvic organs
TOP DIFFERENTIAL DIAGNOSES
• Pyometra
• Endometritis
KEY FACTS
• Muco/hydrometrocolpos
• Gestational trophoblastic disease
• Retained products of conception
• Complex adnexal mass
PATHOLOGY
• Imperforate hymen
• Müllerian duct anomaly
• Cloacal malformation
• Cervical/vaginal stenosis
CLINICAL ISSUES
• Presents at puberty if associated with MDA
• Presents later if associated with cervical cancer
DIAGNOSTIC CHECKLIST
• Distended uterine &/or vaginal cavities with heterogeneous
avascular material
• HM/HC should be considered in young female patients with
lower abdominal symptoms or back pain
(Left) Longitudinal
transabdominal US in a
patient with vaginal atresia
shows a distended vagina with
thin walls ſt containing
hypoechoic heterogeneous
fluid consistent with
hematocolpos. Note the
thicker walls of the distended
uterine cavity . (Right)
Longitudinal transvaginal
ultrasound in a patient with
uterine fibroids and irregular
bleeding shows a distended
endometrial cavity ſt
containing hypoechoic fluid
and echogenic material
consistent with
hematometros.
(Left) Longitudinal
transabdominal ultrasound of
the uterus shows distention of
the uterine ſt and cervical
cavities with homogeneous
echogenic material ,
consistent with hematometros
in this patient with cervical
stenosis. (Right) Longitudinal
transabdominal in a patient
with imperforate hymen
shows a markedly distended
cervical canal containing
hypoechoic, heterogeneous
fluid, consistent with
hematocolpos. There is less
severe distention of the
uterine cavity.
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