William McGarry, MD

Northwestern Memorial Hospital


Martha Saker, MD

Lurie Children's Hospital


11 year old premenarchal female with lower abdominal pain, found to have hematocolpos due to an imperforate hymen.


hematocolpos, imperforate hymen, ultrasound, unknown #1863

Publication Date: 2014-09-14


11 year old premenarchal female presents with lower abdominal pain, right greater than left.


Pelvic ultrasound demonstrates an 11.5 cm fluid collection centered on the cervical os, suggesting that the mass represents a distended, fluid-filled vagina. Layering echogenic material is seen at the posterior aspect of this cystic lesion. Both ovaries are larger than would be expected for a premenarchal female and contain multiple follicles. The endometrial stripe measures 1.3 cm, thicker than would be expected for a premenarchal female.






This 11 year-old premenarchal female presented with lower abdominal pain, and ultrasound was obtained to evaluate for appendicitis or ovarian torsion/cyst. Ultrasound demonstrated a cystic midline mass containing layering echogenic material. This mass was centered on the cervical os, indicating that the mass represented a distended, fluid-filled vagina. The patient was also noted to have a prominent endometrial stripe and large ovaries containing multiple follicles, findings more suggestive of a postmenarchal female. The patient was taken to the operating room, where examination under anesthesia demonstrated an imperforate hymen. Subsequent hymenectomy was performed, with drainage of 250 cc of old blood from the vagina, confiming the diagnosis of hematocolpos.

Hematocolpos refers to a dilated, blood-filled vagina without associated blood in the uterine cavity, distinguishing it from hematometrocolpos. The typical presentation of hematocolpos is pelvic pain and/or a pelvic mass, with ultrasound findings of a cystic midline mass containing internal echoes. In adolescent females, hematocolpos most commonly results from an imperforate hymen, as was the case in our patient. An imperforate hymen occurs infrequently, with a prevalence of approximately 0.1% in female infants. It is typically not associated with additional congenital abnormalities. Complications associated with an imperforate hymen include pelvic abscess, endometritis/myometritis, urinary tract infection, and endometriosis. A transverse vaginal septum is also a cause of hematocolpos but occurs less commonly and is usually accompanied by other urinary tract abnormalities.



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