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Case Report
Ultrasonic Detection of a Single Vaginal
Ectopic Ureter Inserted into an
Imperforate Hemivagina
Chung-Pin Sheih,1 Chien-Dai Chiang,2 Yang-Jann Liao,3 Yiu-Wah Li4
1
Department of Pediatric Nephrology, Taipei Municipal Women and Children’s
Hospital, No. 12 Fu-Chou Street, Taipei, Taiwan, ROC
2
Department of Obstetrics-Gynecology, Taipei Municipal Women and Children’s
Hospital, Taipei, Taiwan, ROC
3
Department of Radiology, Taipei Municipal Women and Children’s Hospital,
Taipei, Taiwan, ROC
4
Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan, ROC
Received 18 January 1996; accepted 1 August 1996
Unilateral imperforate hemivagina with hematocolpos is a rare congenital anomaly.1–3 This
anomaly often is associated with ipsilateral renal
agenesis but, in a few cases, is associated with
ipsilateral renal dysplasia with a single vaginal
ectopic ureter.4,5 For identifying these fluid-filled
genitourinary anomalies, ultrasonography is now
the best procedure.3 We report the ultrasonic detection of a single vaginal ectopic ureter inserted
into an imperforate hemivagina.
CASE REPORT
A 22-year-old woman was first referred to this
department when she was 13 years old for an abdominal mass on the right side. At that time, a
physical examination disclosed a palpable mass
in the right abdomen near the umbilicus. Abdominal sonography revealed a reni-form mass about 6
cm in length containing some small cysts but
without corticomedullary differentiation. Absence
of the kidney in left renal fossa was noted. An
intravenous urogram showed non-visualization of
the left kidney with compensatory hypertrophy of
the right kidney. Therefore, a crossed ectopic dysplastic kidney was suggested. Intermittent mild
urinary dribbling had also been noted since early
Correspondence to: C.-P. Sheih
J Clin Ultrasound 25:133–135, March/April 1997
© 1997 John Wiley & Sons, Inc.
CCC 0091-2751/97/030133-03
VOL. 25, NO. 3, MARCH/APRIL 1997
childhood. She and her parents refused further
investigation and surgery. After menarche, she
had vaginal discharge during her inter-menstrual
period.
Recently, foul purulent vaginal discharge was
found, and she was admitted to our department.
Abdominal sonography and magnetic resonance
imaging (MRI) revealed double uteri with left hematocolpos and an ectopic ureter inserted into a
dilated left hemivagina (Figures 1–3). Excision of
the vaginal septum was performed. Convalescence was uneventful. She awaits renal surgery to
remove the dysplastic kidney in the near future.
DISCUSSION
Unilateral imperforate hemivagina is a rare
anomaly. To date, only approximately 180 cases
have been documented.1,3 Progressive accumulation of blood in the occluded genital tract usually
develops after menarche in patients with this
anomaly.3 The presenting symptoms include abdominal pain, increasing dysmenorrhea, a pelvic
mass, and/or vaginal discharge.1 Embryologically, unilateral imperforate hemivagina may result from the failure of fusion of the paired Mullerian ducts and subsequent interference with the
normal process of absorption of the uterovaginal
septum.6 This anomaly is induced by a maldeveloped Wolffian duct. Therefore, it is always asso133
CASE REPORT: SHEIH ET AL.
FIGURE 1. Transverse pelvic sonography shows double uteri (U) with
left vaginal dilatation (V) behind the bladder.
FIGURE 2. Longitudinal pelvic sonography reveals a dilated ureter
(arrowheads) inserted into the dilated vagina (V) behind the bladder.
ciated with renal agenesis or renal dysplasia with
a single vaginal ectopic ureter.4–7
There are two types of single vaginal ectopic
ureters. In the first type, an ectopic ureter inserts
directly into the vaginal cavity, as in this case. In
the other, the ectopic ureter empties into a Gartner’s duct cyst in the vaginal wall.7–11 In a girl
with a single vaginal ectopic ureter, common presenting symptoms are urinary dribbling and/or
urinary tract infection.
Unilateral imperforate hemivagina associated
with a single vaginal ectopic ureter is very rare.
In 1966 and 1982 respectively, Constantian and
Gilsanz et al documented a dysplastic kidney
134
FIGURE 3. MRI (TR/TE: 4000/102) shows a dilatedureter (arrowheads)
inserted into the dilated vagina (V).
with an ectopic ureter opening into the occluded
half of the double vagina.4,5 Sheih et al described
a unilateral imperforate hemivagina associated
with ipsilateral renal malformation and a Gartner’s duct cyst in 1993.7 To date, fewer than 15
cases of such anomalies have been reported.
Because ultrasonography is an excellent, easily
performed, and non-invasive method to identify a
fluid-filled cystic or tubular structure, it has become the first diagnostic imaging modality for detecting an occluded genitourinary tract.3,7 In patients with an imperforate hemivagina, unilateral
hematocolpos occurs after menarche. Menstrual
blood in the vagina shows low-level echoes or an
echo-free appearance with ultrasound. Ultrasonography can usually identify this anomaly.3
Because the distal orifice of the ectopic ureter
is often stenotic, most ectopic ureters are dilated
behind the bladder. Ultrasonography can usually
detect such dilated ectopic ureters. With the development of high resolution, real-time scanners,
ultrasonography can now pinpoint the insertion
site of an ectopic ureter in some cases.9,12 In this
patient, ultrasonography demonstrated that an
ectopic ureter was inserted directly into the dilated imperforate hemivagina. To our knowledge,
this is the first case of ultrasonic demonstration of
such an anomaly.
REFERENCES
1. Morgan MA, Thurnau GR, Smith ML: Uterus didelphys with unilateral hematocolpos, ipsilateral
renal agenesis and menses: a case report and literature review. J Reprod Med 32:47–58, 1987.
JOURNAL OF CLINICAL ULTRASOUND
ECTOPIC URETER AND IMPERFORATE HEMIVAGINA
2. Yoder IC, Pfister RC: Unilateral hematocolpos and
ipsilateral renal agenesis: report of two cases and
review of literature. Am J Roentgenol 127:303–308,
1976.
3. Sheih CP, Li YW, Liao YJ, et al: Early detection of
unilateral occlusion of duplicated Mullerian ducts:
the use of serial pelvic sonography for girls with
renal agenesis. J Urol 151:708–710, 1993.
4. Constantian HM: Ureteral ectopia, hydrocolpos,
and uterus didelphys. JAMA 197:124, 1966.
5. Gilsanz V, Cleveland RH, Reid BS: Duplication of
Mullerian ducts and genitourinary malformations:
analysis of malformations. Radiology 144:797–801,
1982.
6. Magee MC, Lucey DT, Fried FA: A new embryologic classification for uro-gynecologic malformations: The syndromes of mesonephric duct induced
Mullerian deformities. J Urol 121:265–267, 1979.
7. Sheih CP, Li YW, Chen WL, et al: Unilateral occlusion of duplicated Mullerian ducts associated
VOL. 25, NO. 3, MARCH/APRIL 1997
8.
9.
10.
11.
12.
with ipsilateral Gartner’s dust cyst: report of 3
cases. J Urol 149:543–545, 1994.
Gotoh T, Morita H, Tokunaka S, et al: Single ectopic ureter. J Urol 129:271–274, 1983.
Sheih CP, Hung CS, Wei CF, et al: Cystic dilatations within the pelvis in patients with ipsilateral
renal agenesis or dysplasia. J Urol 144:324–327,
1990.
Gotoh T, Koyanagi T: Clinicopathological and embryological considerations of single ectopic ureters
opening into Gartner’s duct cyst: a unique subtype
of single vaginal ectopia. J Urol 137:969–973,
1987.
Currarino G: Single vaginal ectopic ureter and
Gartner’s duct cyst with ipsilateral renal hypoplasia and dysplasia (or agenesis). J Urol 128:
988–993, 1982.
Hantman SS: Sonographic diagnosis of vaginal ectopic ureter. J Ultrasound Med 2:523–254, 1983.
135
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