Diagnostic Ultrasound - Abdomen and Pelvis

Gartner Duct Cyst
Diagnoses: Female Pelvis
○ Cervical fibroid
– Solid, arises from cervical stroma
PATHOLOGY
General Features
• Associated abnormalities
○ Müllerian duct anomalies
– Unicornuate, bicornuate, didelphys, or septate uterus
– Carry ↑ risk for infertility, spontaneous abortion
– May present with hematocolpos/primary amenorrhea
in setting of müllerian anomalies
○ Renal anomalies
– Ipsilateral renal dysgenesis/agenesis
– Cross-fused ectopia/ectopic ureter
○ Diverticulosis of fallopian tubes (salpingitis isthmica
nodosa)
– Associated with increased incidence of
infertility/increased risk for ectopic
• Embryology
○ Mesonephric ducts normally resorb in females
○ Remnants form interrupted channel along genital tract
→ GD
○ Dilatation of lower portion of mesonephric duct
remnants → GDC
– Commonest in vaginal wall
○ Ureteral bud also develops from mesonephric duct
– Associated renal/ureteric anomalies are common
CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Usually asymptomatic
○ Incidental finding on transvaginal ultrasound
○ Incidental finding on pelvic examination
– Usually soft to palpation
• Other signs/symptoms
○ May be symptomatic if large
– Pelvic pressure symptoms
– Dyspareunia
– Obstructed labor
– Mass at introitus described in neonate
○ May present with urologic symptoms
– Cyst may be seen posterior to bladder or protrude
into bladder, mimicking ureterocele
– May cause ureteric or urethral obstruction
– Reported cases of recurrent urinary retention in
children requiring surgical resection of GDC
– Urinary incontinence
– Large GDC may mimic cystocele or urethral
diverticulum
Demographics
• Epidemiology
○ Remnants of GD can be detected in 25% of adult women
○ GDC reported to occur in 1-2% of women
Natural History & Prognosis
• No specific treatment required if asymptomatic
• Infection/hemorrhage may cause acute pain
• Large cysts tend to be symptomatic
• GDC may recur postoperatively
○ Recurrences tend to be multilocular
– May be mistaken for ovarian carcinoma, lymphocele,
abscess
○ Pelvic MR will show location inferior to levator plate
• Clear cell adenocarcinoma or malignant female adnexal
tumor of wolffian origin (FATWO) from GDC are very rare;
can present with vaginal bleeding and irritation
Treatment
• If symptomatic
○ Aspiration
○ Sclerotherapy
– Aspirate fluid
– Inject with 5% tetracycline solution in volume equal to
aspirate
– Tetracycline solution reaspirated after 24 hours
○ Marsupialization
○ Surgical excision
• Check uterine/renal anatomy for possible associated
malformations
DIAGNOSTIC CHECKLIST
Consider
• In young females with ipsilateral renal dysgenesis, a
ureterocele-like "cyst" without associated ureteric
dilatation is highly suspicious for GDC
○ Strong association with other wolffian duct as well as
müllerian duct anomalies
○ Reported obstructing vaginal septum
Image Interpretation Pearls
• In infant with pelvic cyst, distension of vagina with saline
allows confirmation that cyst arises in vaginal wall
• Associated with müllerian duct/renal/ureteral anomalies
○ If cyst seen on pelvic imaging, check kidneys
SELECTED REFERENCES
1. Shobeiri SA et al: Evaluation of vaginal cysts and masses by 3-dimensional
endovaginal and endoanal sonography. J Ultrasound Med. 32(8):1499-507,
2013
2. Surabhi VR et al: Magnetic resonance imaging of female urethral and
periurethral disorders. Radiol Clin North Am. 51(6):941-53, 2013
3. Dwarkasing RS et al: MRI evaluation of urethral diverticula and differential
diagnosis in symptomatic women. AJR Am J Roentgenol. 197(3):676-82,
2011
4. Chaudhari VV et al: MR imaging and US of female urethral and periurethral
disease. Radiographics. 30(7):1857-74, 2010
5. Bats AS et al: Malignant transformation of Gartner cyst. Int J Gynecol Cancer.
19(9):1655-7, 2009
6. Dwyer PL et al: Congenital urogenital anomalies that are associated with the
persistence of Gartner's duct: a review. Am J Obstet Gynecol. 195(2):354-9,
2006
7. Macura KJ et al: MR imaging of the female urethra and supporting ligaments
in assessment of urinary incontinence: spectrum of abnormalities.
Radiographics. 26(4):1135-49, 2006
8. Prasad SR et al: Cross-sectional imaging of the female urethra: technique
and results. Radiographics. 25(3):749-61, 2005
9. Hahn WY et al: MRI of female urethral and periurethral disorders. AJR
182:677-82, 2004
10. Eilber KS et al: Benign cystic lesions of the vagina: a literature review. J Urol.
170(3):717-22, 2003
11. Sherer DM et al: Transvaginal ultrasonographic depiction of a Gartner duct
cyst. J Ultrasound Med. 20(11):1253-5, 2001
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