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2005-03-24-14 Answer to the case of the week #141 © Jeanty www.TheFetus.net
Answer to the case of the week #141

April 7- April 21, 2005

Philippe Jeanty, MD, PhD
Tennessee Women"s Care, Nashville TN

This is a woman who presented for a routine ultrasound scan and the following images were obtained. They demonstrate a duplication of the collecting system but mostly a perineal cystic collection that is NOT the bladder but communicates with the bladder:

 

The following is a video-clip demonstrating the passage of urine from the bladder into the cystic mass and what appeared to be labia majora fused over the "cyst":

The ultrasound findings suggest the presence of a cystic structure seen close to but external to the introitus. This was likely to be external to the hymen so it did not appear to represent a hydrocolpos. This was essentially a urinoma that developed due to Labial fusion leading to obstruction of the urinary flow. Since the amniotic fluid was normal we assumed there must have been a slow leak although we could not demonstrate it.

The following is a postnatal photograph of the female neonate, demonstrating the fused labia majora. They were surgically separated and the introitus and the rest of the baby was normal (aside for the duplication of the collecting system of course)

 

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