Differential Diagnosis of Vaginal Masses
· Hematocolops- Obstruction of the genital canal may occur from several causes. and may result in the collection ofblood (hematometra), fluid (hydrometra) or pus (pyometra) in the uterus. Sonographically, there is a cystic distention of the genital canal; the size and location of the fluid collection depends upon the site of obstruction. Hematocolpos is the collection of blood within the vagina.
· Gartner's duct cysts- These usually lie proximal to the vagina in the adnexa or along the anterolateral aspect of the vaginal wall. Arising from mesonephric duct remnants, they are the most common cystic vaginal masses. They are usually incidental findings.
· Vaginal inclusion cysts- These are related to the inclusion of the vaginal epithelium during surgery and usually found as cystic masses in the posterior or lateral wall of the vagina.
· Mucinous cysts- These are related to a developmental anomaly due to remnants of the incomplete separation of the rectum and urogenital sinus by the urachal fold.
· Endometriosis-Aberrant endometrial tissue may be present in the vagina, the most common site being the posterior fornix. It may be entirely cystic, or may appear as a complex mass. The mass may be subject to cyclical change.
· Urethral diverticula-Usually acquired, they are said to be present in 3% of asymptomatic women, but are an often overlooked cause of lower urinary tract symptoms. They may occur anywhere along the urethra but most are found in the midurethra. The size may vary from millimeters to several centimeters and may be multilocular. Calculi and/or tumors may occur within the diverticula.
· Ureteroceles-In about 40% of ureteroceles, the orifice opens outside the bladder, proximal or distal to the external sphincter. These cystic swellings may project into the vagina and can be recognized on sonography.
· Cystoceles-This is a form of vaginal prolaps of the bladder/and urethra. Sonography may reveal a midline cysti swelling in the vagina in communication with the bladder.
· Foreign body-Foreign body, e.g. tampon (appearance is variable) may be seen as a very echogenic mass with shadowing, but when soaked in fluid the texture of the material may be discernible on US. The possibility of a foreign body should always be remembered in children, who may give no history of insertion of the article, which may have been present for some time.
· Leinomyoma-Pedunculated leiomyomas may prolapse through the cervix into the vagina and be seen as a hypoechoic mass.
· Leiomyoma of urethra- This has been described as a well defined, hypoechoic mass in the region of the urethra, in relationship to the anterior vagina/vulva on transvaginal sonography.
· Vaginal polyp-They may be single or multiple finger-like projections; either echogenic or low reflectivity on US.
· Neoplasms- True vaginal tumors are rare in children and uncommon in adults. Clear cell carcinoma may be associated with DES exposure in utero. Primary and secondary tumors are usually seen as solid heterogeneous masses.
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