Maryam Bahreini, Fatemeh Rasooli, Mojtaba Chardoli

LEARNING OBJECTIVE

The discrepancy between menarcheal status and tanner stage should raise the suspicion for imperforated hymen, the early diagnosis of which can prevent infectious and fertility complications.

Ultrasonography is a useful tool to investigate the female genital and urinary system.

AIM

Ultrasonography has widely applicable in the diagnosis of female pelvis abnormalities.

CASE PRESENTATION

A 14-year old girl complained of urinary retention lasting for 4 hours.

She reported dribbling and stranguria before complete retention without dysuria, polyuria or hematuria.

No fever, abdominal pain or nausea/vomiting was present.

She was well-grown for her age, developing pubic hair and breast buds but she did not yet experience menstruation. Past medical history was unremarkable. Vitals were within normal range for age.

Physical exam did not show abnormal mass or tenderness, neither a full bladder.

RESULTS

Point-of-care ultrasonography revealed a one-quarter full bladder, a large hematocolpos and a normal size empty uterus.

No free fluid was detected. During foley catheter insertion, the opening of the vagina was not evident, the anal and urethral openings were anatomically normal and 200 cc urine was drained.

The diagnosis was confirmed as an imperforated uterus.

The ultrasonography of kidneys and urinary system was documented normal.

CONCLUSION

The discrepancy between menarcheal status and tanner stage should raise the suspicion for imperforated hymen, the early diagnosis of which can prevent infectious and fertility complications.

Ultrasonography is a useful tool to investigate the female genital and urinary system and can efficiently detect related pathologies

Figure 1: Transabdominal short-axis female pelvic ultrasonography showing a large hematocolpus (blue arrow) and a normal size empty uterus (green arrow).