阴道斜隔综合征影像学诊断

目的:探讨阴道斜隔综合征的影像学表现。方法:回顾性分析5例阴道斜隔综合征的临床及影像表现。结果:2例行子宫输卵管造影检查,1例显示单角子宫,1例显示双子宫,2例均显示隔后腔及阴道斜隔上的瘘管。4例行CT检查,均显示双子宫、双宫颈、双阴道,其中斜隔侧阴道远端闭锁形成隔后腔。5例均经B超、CT或静脉肾盂造影(IVP)证实伴有斜隔侧肾及输尿管缺如。5例中右侧斜隔4例,左侧斜隔1例。所有患者均为双子宫、双宫颈、双阴道,一侧阴道完全或不完全闭锁及斜隔侧肾、输尿管缺如为特征。结论:阴道斜隔综合征的影像学表现具有一定特征性,影像学检查对该病的诊断具有重要价值。     

阴道斜隔综合征的影像学特征及诊断价值

目的 探讨阴道斜隔综合征的影像学表现及其诊断价值.方法 回顾性分析13例阴道斜隔综合征患者的临床及影像学资料并复习相关文献.13例术前均行超声检查,其中8例行MRI检查,并行CT检查3例.分析斜隔的位置,隔后腔的大小,隔后腔与宫颈的位置关系,双侧附件及泌尿系的伴发改变.结果 超声、MRI检查均表现为双子宫、双宫颈、双阴道且一侧阴道闭锁,斜隔起于两侧宫颈之间,斜行附着于一侧阴道壁,遮蔽该侧宫颈;斜隔位于右侧4例,左侧9例;6例 Ⅰ 型隔后腔容积平均为255 mL,6例Ⅱ型隔后腔容积平均为74 mL,1例Ⅲ型隔后腔容积为56 mL;合并斜隔侧输卵积血2例,合并斜隔侧卵巢巧克力囊肿1例;伴斜隔侧肾缺如12例,伴斜隔侧肾发育不全1例.3例CT检查均表现为双子宫、双宫颈,一侧宫颈下方囊状低密度影及同侧肾缺如.结论 阴道斜隔综合征的影像学表现颇具特征性.超声、CT和MRI对准确诊断有一定价值.     

阴道斜隔综合征的MR影像特征

目的探讨阴道斜隔综合征(Herlyn-Werner-Wunderlich综合征)的MR影像特征及鉴别诊断。方法回顾性分析经宫腔镜、腹腔镜及手术证实的14例先天性阴道斜隔病人的MRI影像和临床资料,依据美国生育学会(AFS)阴道发育异常分类对阴道斜隔综合征进行影像学诊断及分型。结果本研究确诊阴道斜隔综合征14例,其中2例为阴道斜隔Ⅱ型,其他均为阴道斜隔Ⅰ型。MRI均表现为双子宫、双宫颈畸形,且同时合并有患侧肾脏缺如,患侧宫颈与其相通的阴道积血、扩张,T_1WI呈高信号,T_2WI呈低或混杂信号。结论阴道斜隔综合征的MRI影像表现有一定特征,MRI能更准确地评估其类型及相关并发症并做出客观诊断,可作为术前影像评估的最佳有效的检查方法。     

阴道斜隔综合征的影像学诊断价值

目的分析阴道斜隔综合征的影像学表现,探讨影像学检查在阴道斜隔综合征诊断中的价值。资料与方法8例阴道斜隔综合征患者,于术前作了多种影像学检查,包括子宫输卵管造影、隔后腔造影、静脉肾盂造影、盆腔超声成像、泌尿生殖系CT及MRI。将影像学表现与手术结果进行对比分析。结果5例行子宫输卵管造影,其中1例显示双子宫,4例显示单角子宫;4例作了隔后腔造影,显示腔隙为梭形3例,不规则形1例;7例作了盆腔超声成像,3例报告双子宫,3例报告子宫旁肿块,1例疑盆腔异位肾;2例作了盆腔CT,均显示双子宫畸形并一侧宫颈扩张;4例作了盆腔MRI,均显示双子宫畸形并一侧子宫腔及隔后腔积液或积血;8例经静脉肾盂造影、肾脏超声成像、MRI或CT检查提示一侧肾缺如;8例经手术或阴道镜证实阴道斜隔及隔后腔的存在。结论阴道斜隔综合征的诊断关键在于提高对本病的认识。MRI在显示本病畸形解剖方面优于其他影像学方法,对本病的诊断有重要的价值。     

Herlyn-Werner-Wunderlich综合征的影像特征

目的 探讨Herlyn-Werner-Wunderlich综合征(HWWS)的影像特征.方法 回顾性分析经临床诊断的11例HWWS患者资料,行腹、盆腔CT和(或)MRI检查,分析其影像特征.结果 11例患者腹、盆腔CT和(或)MRI上均表现为双子宫、双宫颈、双阴道并一侧肾缺如,其中左侧5例,右侧6例.8例合并斜隔侧子宫、宫颈内积血、积液,左侧5例,右侧3例,CT平扫表现为稍高密度,增强后无强化,MRI T1WI呈高信号,T2WI呈低或混杂信号.2例合并子宫多发肌瘤(肌壁间).1例合并右侧卵巢子宫内膜异位.1例合并阴道癌并淋巴结转移.结论 HWWS的影像表现具有特征性,影像学检查特别是MRI可以提供更多的信息.     

阴道斜隔综合征的MRI诊断

【摘要】目的：探讨MRI对阴道斜隔综合征中的诊断价值。方法：对39例阴道斜隔综合征患者的MRI图像进行回顾性分析,以手术术中所见为确诊标准。结果：39例阴道斜隔综合征中,Ⅰ型9例,Ⅱ型24例,Ⅲ型6例。斜隔发生于右侧者26例,发生于左侧者13例。同时伴有的子宫畸形为：双子宫畸形26例,双角子宫6例,完全纵隔子宫7例。36例伴斜隔同侧肾脏缺如。盆腔内其他病变：盆腔积液34例;内膜样囊肿4例;一侧输卵管积血或积液7例。本组MRI诊断Ⅰ型 或Ⅱ型共33例,其中发现斜隔上小孔从而确诊为II型的为2例,Ⅲ型6例,全部诊断准确。结论：MRI可以准确诊断阴道斜隔综合征,对该病诊断有重要的应用价值。     

阴道斜隔综合征5例

<正>阴道斜隔是一种较少见的阴道发育异常,阴道斜隔综合征是包括双宫体、双宫颈、单肾缺如、阴道斜隔、隔后腔积血而致痛经、阴道壁及盆腔包块,这种先天性畸形不为人们所熟悉,往往延误诊断,甚至错误治疗。1临床资料本组5例均为本院1995—2011年我院住院病人,年龄     

阴道斜隔综合征的超声诊断（附3例报告）

目的：探讨阴道斜隔综合征（oblique vaginal septum syndrome ,OVSS）声像图特点,提高超声诊断准确率、降低误诊、漏诊率。方法分析3例OVSS超声声像图特点及临床特征,总结该病的诊断要点。结果3例患者均有不规则阴道流血史,超声显示均为双子宫、双宫颈,伴宫颈管积液、阴道积液,斜隔侧肾缺如,3例均为II型OVSS。结论超声检查可以作为OVSS诊断的首选方法。     

阴道斜隔综合征

阴道斜隔综合征是一种包括双子宫、单肾缺如、阴道畸形的先天畸形，不为人们所熟悉，往往延误诊断与治疗。本文收集到4例，介绍如下。      

胎儿子宫阴道积液的产前MRI诊断

回顾性分析2014年1月至2021年8月湖北省妇幼保健院12例子宫阴道积液胎儿的临床及MRI资料。5例产前诊断为泄殖腔畸形胎儿均在引产后得到证实, 其中3例为双子宫双阴道, 5例均表现为子宫阴道扩张积液, T2WI上积液信号与膀胱信号相似, T1WI上直肠高信号未见, 结肠扩张, 腹腔积液, 肾积水。7例产前诊断为单纯梗阻性子宫阴道积液的胎儿表现为子宫阴道扩张积液, T1WI上直肠高信号存在, 2例引产及1例生后随访证实为阴道斜隔, 2例生后手术证实为单纯处女膜闭锁, 2例引产证实为阴道闭锁。产前MRI可以排除泄殖腔畸形引起的胎儿子宫阴道积液, 但对单纯梗阻性胎儿子宫阴道积液鉴别诊断困难。     

Association of renal agenesis and mullerian duct anomalies

PURPOSE: The purpose of this work was to determine the association of renal agenesis with the different types of mullerian duct anomalies (MDAs). METHOD: A 5 year retrospective review of MR records identified 57 patients with MDAs. Associated renal anomalies were correlated with the various types of MDAs. RESULTS: Renal agenesis was found in 17 (29.8%) of 57 patients. No other renal anomalies were identified. Renal agenesis was more frequent in patients with uterus didelphys (13/16 cases). Renal agenesis was also seen in patients with uterine agenesis (2/5 cases) and unicornuate uterus (2/7 cases). All 11 cases of obstructed uterus didelphys were associated with renal agenesis ipsilateral to the side of the obstructing transverse hemivaginal septum. CONCLUSION: Renal agenesis is more commonly seen in uterus didelphys than in other types of MDAs. Renal agenesis in patients with uterus didelphys is often ipsilateral to an obstructing, transverse, hemivaginal septum.     

Herlyn-Werner-Wunderlich syndrome: A case report in a young woman,with literature review

Herlyn-Werner-Wunderlich syndrome is a rare complex congenital disorder, with combined Müllerian and mesonephric duct anomalies, presenting with uterus didelphys, unilateral blind hemivagina and ipsilateral renal agenesis. Hemivaginal obstruction usually leads to impairment of normal menstrual flow, resulting in symptoms after menarche, namely dysmenorrhea, pelvic pain or infertility. Age of presentation depends on the anatomical features of this anomaly. We report a case of a 21-year-old female presenting with few symptoms and incidental findings on transvaginal ultrasound, with typical findings of this disorder on magnetic resonance imaging, which remains the gold standard imaging technique for thorough assessment of Herlyn-Werner-Wunderlich syndrome, allowing for a correct diagnosis and adequate surgical management. Our case also highlights some unusual features, such as the presence of a blind ectopic ureter, with hematic content, and an incomplete septum within the obstructed hemivagina.     

临床拟诊为独肾患者的影像学诊断

目的：探讨腹部影像检查表现为“独肾”患者的全腹部及盆腔CT和／或MRI影像特征及其发病规律。方法：回顾性分析2007年-2011年腹部影像呈“独肾”表现的48例患者的腹盆腔CT或MRI检查资料。年龄1个月～78岁（其中30岁以下37例）,男17例,女31例。其中行CT检查36例,MRI检查12例。结果：48例中先天性孤立肾7例,一侧发育正常的异位肾（低位肾）2例,一侧肾发育不良并低位4例,余35例均合并其它泌尿生殖系异常（72％）,均经临床或手术证实。35例中肾发育不良并低位及各种输尿管异常14例;肾缺如并同侧精囊囊肿（Zinner’s syndrome）7例;肾缺如或肾发育不良加子宫发育异常12例;多重复杂变异2例。影像特征和发病规律：①肾缺如或发育不良常合并其它泌尿生殖道畸形,大部分为同侧泌尿生殖系异常。②肾缺如常合并生殖系异常,而肾发育不良时多见泌尿系（尤其是输尿管下段）异常。③发育不良的肾几乎都出现在输尿管走行区,体积一般小于正常,大部分为低位（腰3椎体水平以下至盆腔内）。④性别特异性：男性为Zinner综合征（中肾管未发育导致肾缺如,残留于精囊形成囊肿）,女性出现多种子宫异常。输尿管异常男女均可发生,女性更易同时出现输尿管异位开口。结论：对于初诊腹部影像学表现为“独肾”的患者,全腹部及盆腔影像学检查是非常必要的,可进一步明确诊断。这类患者常合并泌尿生殖系异常,其病变位置、病变类型有一定规律,应重点观察同侧输尿管、精囊和子宫。     

先天性子宫畸形的MRI诊断价值

目的探讨MRI对先天性子宫畸形的诊断价值。资料与方法回顾性分析8例先天性子宫畸形的MRI资料。结果单纯双子宫畸形2例,双子宫畸形伴阴道纵隔1例,双角子宫伴左侧卵巢囊肿1例,完全纵隔子宫2例,完全纵隔子宫伴阴道纵隔2例。结论MRI可以显示不同子宫畸形的官腔结构及宫底外观形态、各种复杂畸形及并发的其他病变,是诊断先天性子宫畸形的可靠方法。     

OHVIRA syndrome presenting with acute abdomen: a case report and review of the literature

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) or Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital anomaly. A 13-year-old female presented with acute abdominal pain and dysmenorrhea. Ultrasonography and magnetic resonance imaging showed uterus didelphys, hematometrocolpos, obstructed hemivagina, and right renal agenesis. Hemivaginal septal resection and anastomosis between the obstructed hemivagina and the normal vagina was tried, but it was not possible. Unilateral hysterectomy was performed. HWW syndrome may present with acute abdomen and is usually treated with vaginal septum resection and drainage of the hematometrocolpos.     

The Herlyn-Werner-Wunderlich (HWW) syndrome – A case report with radiological review

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of female urogenital tract involving combined mullerian duct anomalies and mesonephric duct malformation characterized by uterus didelphys, obstructed hemi-vagina and ipsilateral renal agenesis which is also known as OHVIRA syndrome. It can be classified based on a completely or incompletely obstructed hemivagina. It presents soon after menarche or shows delayed presentation depending on the type. The most common presentation is lower abdominal pain, dysmenorrhea, and abdominal mass in the lower abdomen secondary to hematometra or hematocolpos. We present a 15-year-old unmarried patient with an unusual case of OHVIRA syndrome suffering from dysmenorrhea and painful mass in suprapubic region. We described the role of imaging modalities in diagnosis of the Herlyn-Werner Wunderlich syndrome with a review of literature. On USG and MRI, she had right renal agenesis with compensatory hypertrophy of the left kidney, didelphic uterus with an obstructed hemi-vagina on right side which led to marked distention of ipsilateral cervix and proximal vagina in the form of hematometrocolpos. OHVIRA syndrome can present early or late, depending on the type. In patients with uterine and vaginal abnormalities, a work-up for associated renal anomalies should be performed. The choice imaging modalities for the diagnosis of OHVIRA syndrome are ultrasound and MRI. Knowing the imaging findings of this rare condition is crucial for early diagnosis in order to prevent complications which may lead to endometriosis and infertility.     

MR evaluation of uterine anomalies

The MR features of uterine anomalies were analyzed in eight women. Scans were done on a 1.5-T magnet with T1-weighted (TR 600 msec, TE 25 msec) and T2-weighted (TR 2000-2500 msec, TE 35-80 msec) spin-echo images obtained in several planes. The anomalies consisted of bicornuate uterus (three cases), septate uterus (one case), bicornuate uterus with septation (two cases), unicornuate uterus (one case), and uterus didelphys with vaginal septum (one case). These diagnoses were confirmed by hysterosalpingography with laparoscopy (five cases), dilation and curettage with laparoscopy (one case), or cesarean section (two cases). In six of the eight cases, MR correctly identified and accurately classified the type of anomaly. In the other two cases, the MR diagnosis was a bicornuate uterus with septation. One case proved to be a uterus didelphys with vaginal septum, and the other a bicornuate uterus without septation. The study shows that MR is a valuable tool for the diagnosis of uterine anomalies.     

Diagnosis,management, and outcome of obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome): Is there a correlation between MRI findings and outcome?

AimTo review the experience of a single tertiary center with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome) and evaluate if MRI findings correlate with outcome.MethodsPatients (n = 32) diagnosed with OHVIRA syndrome between 2001 and 2019 were analyzed. Presenting symptoms, age of menarche, age at operation, MRI findings, management, and outcome were reviewed. In sagittal MRI planes, distance from hematocolpos to perineum was measured. Measurements were compared among patients who underwent single-stage vaginoplasty and hemihysterectomy.ResultsMean age at diagnosis and mean age of menarche was 16.8 ± 6.4 (10−33) and 12.8 ± 1.0 (10–15). Main presenting complaints were abdominal pain/dysmenorrhea. Eighteen anomalies (56.3%) were on right side. Twenty-eight had ipsilateral renal agenesis, 3 patients had normal renal anatomy and one had unilateral multicystic dysplastic kidney. In MRI, 21 patients had hematocolpos, 11 patients had both hematocolpos and hematometra. 28 patients underwent single-stage vaginoplasty and vaginal septum resection. One had hemihysterectomy due to sepsis at presentation. Three patients had hemihysterectomy due to proximal vaginal septum and impossibility of vaginoplasty. During follow-up, 7 cases (21.9%) had married and 5 of these (71.4%) were pregnant or had delivered. Five patients had reoperation during follow-up. MRI images of 19 patients indicated mean distances from hematocolpos to perineum whom underwent vaginoplasty or hemihysterectomy were 33.9 ± 18.1 mm (10–79 mm) and 87.3 ± 11.0 mm (80–100), respectively (p = .009).ConclusionsGold standard treatment of OHVIRA syndrome is single-stage vaginoplasty. Distance from hematocolpos to perineum in MRI may correlate with surgical outcome. Hemihysterectomy may be an alternative for extreme proximal vaginal septum or infectious complications.     

Herlyn-Werner-Wunderlich syndrome: A report of three cases in adolescents and adult woman

We report three cases with Herlyn-Werner-Wunderlich syndrome in adolescents and young female. The objective of this report was to describe the clinical presentation, ultrasound (US) and magnetic resonance imaging (MRI) findings of Herlyn-Werner-Wunderlich syndrome. The three patients were 12, 13 and 34 years old, respectively. The reason for admission and clinical symptoms varied between the 3 patients, including menstrual cramps, vaginal bleeding, and dull pain in the hypogastric region. Nevertheless, the sonographic and MRI findings of all three cases were typical for HWWS, including didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis.