The untold diseases of the vagina: a review of the most common imaging findings

Congress:

ECR 2020

Poster Number:

C-10661

Type:

Educational Exhibit

Keywords:

Genitourinary, Genital / Reproductive system female, CT, MR, Ultrasound, Education, Education and training, Not applicable

Authors:

A. S. G. Costa¹, A. S. C. C. Germano²; ¹Amadora/PT, ²Barcarena /PT

DOI:

10.26044/ecr2020/C-10661

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10661

Fig. 1: Normal vaginal reflux in a 3-month old girl submitted to a cystourethrography...

Fig. 5: Normal vaginal anatomy at MR in a premenopausal woman. Axial (A) and sagittal...

Fig. 10: Longitudinal vaginal septum of the same patient mentioned in Figure 9. Axial...

Fig. 13: Endometriosis of the vaginal cuff in a 48-year old woman who presented with a...

Fig. 14: Vaginal leiomyoma in a 19-year old woman with a history of prolapsed vulvar...

Fig. 21: Incidentally found vaginal cup in a 34-year old woman. Coronal (A) and axial...

Fig. 25: Emphysematous vaginitis in a 27-year old woman with vaginal bleeding after...

Fig. 27: Sigmoidovaginal fistula in a hysterectomized 71-year old woman due to...

Fig. 29: Rectovaginal fistula in a 66-year old woman submitted to chemoradiotherapy due...

Learning objectives

To review the anatomy and imaging appearance of the normal vagina; To describe and illustrate the most common and overlooked imaging findings of the vagina.

Background

When radiologists interpret a female pelvis examination, they focus on the internal pelvic organs, while the vagina and external structures are commonly neglected. Despite most of the anatomy and diseases of the vagina being better evaluated at physical examination, radiologists should remember to look beyond the uterus and the cervix especially when a gynecologic disease is suspected. This underestimation may happen at ultrasound (US) due to probe positioning or at computed tomography (CT) due to poor definition of vaginal tissue. Although magnetic resonance (MR) has...

Findings and procedure details

From the archives of our institution, we selected US, CT and MR images that demonstrate the spectrum of the most common imaging findings of the normal and pathologic vagina, including congenital anomalies, solid masses, common use foreign bodies, traumatic and inflammatory/infectious conditions. Anatomy of the normal vagina The vagina is a fibromuscular tube that extends from the uterus to the vulvar vestibule, with an average length of 7-9 cm. Usually, its anteroposterior axis is shorter than its transversal axis, except in its upper portion where...

Conclusion

Underrating the vagina in imaging techniques is a common occurrence. To diminish this problem, it is important to acquire knowledge of the anatomy and imaging appearance of the vagina, as well as understanding the most common conditions that involve it. Nevertheless, physical examination is still the most reliable method in vagina assessment. Imaging techniques are essential in clarifying whenever there is doubt.

Personal information and conflict of interest

A. S. G. Costa; Amadora/PT - nothing to disclose A. Germano; Barcarena/PT - nothing to disclose

References

Walker DK, Salibian RA, Salibian AD, Belen KM, Palmer SL. Overlooked Diseases of the Vagina: A Directed Anatomic-Pathologic Approach for Imaging Assessment. RadioGraphics 2011; 31: 1583-1598. Parikh JH, Barton DPJ, Ind TEJ, Sohaib SA. MR Imaging Features of Vaginal Malignancies. RadioGraphics 2008; 28:49-63. Ferreira DM, et al. Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making. Radiol Bras. 2015 Jul/Ago; 48(4): 249-259. Sloin MM, Karimian M, Ilbeigi P. Nonobstetric Lacerations of the Vagina. JAOA 2006; 106(5): 271-273. Yu...