Diagnostic Ultrasound - Abdomen and Pelvis

Gartner Duct Cyst
TERMINOLOGY
Abbreviations
• Gartner duct cyst (GDC)
• Gartner duct (GD)
Definitions
• Secretory retention cysts
○ Remnant of embryonic mesonephric (wolffian) ducts
○ Can occur anywhere along course of duct, most
commonly anterolateral part of proximal 1/3 of vaginal
wall
IMAGING
General Features
• Best diagnostic clue
○ Solitary fluid-filled structure in anterolateral vaginal wall
○ Does not communicate with urethra
• Size
○ Generally < 2 cm diameter
• Same appearance as müllerian cysts: Remnants of
paramesonephric duct, cannot be distinguished from each
other
Ultrasonographic Findings
• Grayscale ultrasound
○ Cyst characteristics
– Anechoic to hypoechoic
– Increased through transmission
– Well-defined wall separate from cervix
○ Infection or hemorrhage → increased echogenicity of
fluid component
○ May contain septa
○ In rare cases, can become quite large and can cause
urethral obstruction
• Color/power Doppler
○ No internal flow on Doppler
○ Helps to confirm cystic nature rather than solid mass,
such as vaginal tumor
Radiographic Findings
• GD may opacify on hysterosalpingography (HSG) if
associated with fistula to vagina
○ Will opacify as focal dilated duct
• GD runs parallel to cervical canal
MR Findings
• T1WI
○ Low signal intensity if simple fluid content
○ Intermediate to high signal intensity if content is
hemorrhagic or proteinaceous in nature
• T2WI
○ High signal fluid content
• In anterolateral vaginal wall
• When large or recurrent, may be multiloculated
Imaging Recommendations
• Best imaging tool
○ Transvaginal sonography is 1st modality of choice
– Ultrasound may fail to differentiate GDC from urethral
diverticulum if connection between diverticulum and
urethra is not well seen
– Light pressure with transducer will minimize
compression of cyst
– Partial withdrawal of transvaginal probe is helpful
– Transperineal sonography is alternative
• Protocol advice
○ Pelvic MR helpful to show location within vaginal
wall/relationship to surrounding tissues
– Always include kidneys on coronal scout images
– Introduction of water-soluble gel into vagina
immediately prior to study improves delineation of
vaginal fornices
○ Improved imaging with endoluminal coil is reported in
literature
DIFFERENTIAL DIAGNOSIS
Cystic Appearance
• Nabothian cysts
○ Within cervix
○ Eccentric to cervical canal
○ GDC is adjacent to but separate from cervix
• Vaginal inclusion cysts
○ Occur as result of obstetric or gynecologic trauma
○ Usually posterior wall
– GDC are anterolateral in location
○ Ask patient about prior deliveries/surgeries
• Endometriosis implant
○ More complex architecture
○ Thick wall, low-level internal echoes
○ Likely to have other manifestations of endometriosis
○ MR likely to show evidence of blood products
• Urethral diverticulum
○ In midurethra, arising in posterolateral wall facing vagina
– Communicates with urethra
– Associated with frequency, urgency, postvoid
dribbling
– When large enough, wraps around urethra in
horseshoe configuration
• Ectopic ureterocele
○ Can occur any where between bladder neck and external
urethral orifice
○ Associated with incontinence and urinary tract infection
○ Can present as cystic vaginal mass,
○ May produce filling defect on voiding
cystourethrography (VCUG)
Solid Appearance
• Vaginal tumor
○ Extremely rare
○ Usually symptomatic
○ Solid mass; palpable, visible on speculum exam
– Squamous cell carcinoma may undergo cystic
degeneration
– Vaginal sarcoma
• Uterine/cervical fibroid
○ Prolapsed submucosal fibroid
– Solid, protrudes though cervix
– Visible on speculum exam
Diagnoses: Female Pelvis
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