Get a Group Membership for your Organization. Free Trial
Pricing
Free TrialLogin

Agenesis

HIDE
PrevNext

0:01

So we'll start with our first case.

0:03

This is a 19-year-old patient who

0:04

came in with primary amenorrhea.

0:06

An outside ultrasound, which I don't have,

0:08

showed a "small uterus, no ovaries."

0:12

She was 46XX as well, just to confirm.

0:17

So we go to the MRI right here.

0:19

We have a T2-weighted image.

0:20

We have a small field of view and you

0:22

can see there's a left ovary here, fairly

0:25

normal size, lots of normal follicles.

0:27

On the right as well, we have

0:28

a normal physiologic dominant

0:30

follicle and lots of tiny follicles.

0:32

You have some tissue down here, and

0:33

then we get into the bladder, right?

0:35

Bladder's right here, rectum back here.

0:38

So vagina should be somewhere right around here.

0:43

There's your vagina, urethra,

0:44

vagina, rectum right here.

0:46

We're really not seeing any significant tissue.

0:49

We don't see a uterus.

0:51

Axial plane imaging of the uterus

0:52

is often very difficult to see.

0:54

So you're going to rely on your other

0:56

sequences, your other fields of view.

0:57

So here is your sagittal sequence.

1:00

So as we scroll through, again, you have

1:01

your bladder here, your rectum here,

1:05

kind of get them all in one plane right here.

1:07

Again, rectum here, anal canal right here,

1:09

bladder, urethra will be right in here.

1:11

That means this is the vagina right here, and we

1:13

just have this little bit of tissue right here.

1:17

And you can scroll through it to see, do you

1:18

think there's a very, very atrophic uterus

1:21

right here, or is this just all vaginal tissue?

1:24

You could have potentially a cervix,

1:26

so you're gonna look for an endometrium.

1:28

If you can see any of that or just the quality

1:30

of the tissue right here, and it all looks

1:32

very similar to the rest of the vaginal tissue.

1:34

All this sort of like mildly

1:36

T2 bright structure right here.

1:38

We don't see anything that shows a

1:40

normal uterus or cervix right here.

1:43

You can also confirm on your coronal image.

1:46

So we go backwards with your bladder right here.

1:49

Vagina should be somewhere right around here,

1:50

and this is all of your tissue right here.

1:53

And now we're all the way back into the rectum.

1:55

Again, some free fluid back

1:56

here, which is physiologic.

1:57

But here's your vaginal tissue right here.

1:59

So this is all just vaginal tissue.

2:01

Almost looks like a hysterectomy in that sense

2:03

where you have this vaginal tissue there.

2:05

So this is considered a hypoplasia right here.

2:09

So we see hypoplastic vaginal tissue.

2:11

We see lots of parametrial vessels.

2:13

That's what all of these are right here.

2:17

And we see our normal ovaries.

2:20

In her particular case, we did do some

2:22

imaging on the T2 of the abdomen to see

2:26

if she had kidneys, and you can see here

2:28

that she does have two kidneys normally

2:29

positioned and look pretty normal.

2:32

No anomalies there.

2:34

So what happens here, this can occur

2:36

because of an interruption of mullerian

2:38

duct development very early in development.

2:40

You can get a complete aplasia, or you

2:43

can get a hypoplasia, and that can include

2:45

the vagina, the cervix, or the uterus.

2:47

So in this case, our patient has

2:48

a vagina, but no cervix or uterus.

2:51

So obviously this patient will not

2:53

be able to carry a pregnancy to term.

2:56

She could have a surrogate potentially because

2:57

she does have ovaries, so she can have a

3:00

surrogate, but there won't be a pregnancy.

3:03

There's nothing you can do about that.

3:05

So in cases like this too, beyond

3:06

that, the goal is also to enable sexual

3:09

function if the vagina itself is affected.

3:11

And in her case, it is not.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

MRI

Gynecologic (GYN)

Body

Acquired/Developmental

© 2024 MRI Online. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy