Search :     
Cases
2013-10-25-10 Case of the week #360 © Deblieck www.TheFetus.net 

 
Answer to the case of the week #360

January 09, 2014 - January 23, 2014

Philippe Deblieck, MD.

Schermbecker Landstr. 88a, 46485 Wesel, Germany.
 

Case report

A 30-year-old woman (G3P1) visited our office for regullar ultrasonographic assesment of peak velocity systolic blood flow in the middle cerebral artery, biometry, and fetal well-being at 32 weeks of pregnancy. Her second trimester ultrasonographic screening was normal. 

The patient had fought off an 
acute Parvovirus infection at 16th week of gestation. Later she had been diagnosed with gestational diabetes and was placed on insulin regimen from 26th week. 

Our ultrasonographic examination at 32 weeks revealed a cystic structure localized in the right upper anterolateral part of the vagina. 

The female neonate was delivered at 40 weeks (3890 g, Apgar 10-10-10, UA pH: 7,34). 
Postnatally the finding was confirmed and the structure showed to be a Gartner's duct cyst

Because of frequent association of the finding with concomitant Wolffian and Müllerian duct developmental anomalies (3,4), the neonate was screened for urological abnormalieties. Pelvic sonography was performed, but except of the Gartner’s cyst no other associated anorectal or urogenital anomalies were found.
 

Images 1, 2, 3, 4, and video 1: 32 weeks of gestation; the images and video show coronal plane crossing the pelvis and female gender of the fetus with cystic structure localized in the right upper anterolateral part of the vagina.

 

 



Images 5, 6, and video 2: 32 weeks of gestation; the image 5 shows color Doppler vizualization of the umbilcal arteries passing around the urinary bladder and no blod flow within the cystic structure localized in the right upper anterolateral part of the vagina (Gartner's duct cyst). The image 6 and video 2 shows normal kidneysof the fetus.

 



Postnatal images

Images 7, 8, 9, 10, 11, and 12: The images show postnatal ultrasonographic imaging of the paravaginal Gartner cyst of the newborn.

 

 

 

Discussion

Differential diagnosis of (para) vaginal cystic lesions in the newborn includes (1,2,5):

  • Gartner’s duct cyst;
  • ectopic ureterocele (cystic dilatation of the distal ureter may present as a cystic vaginal mass)
  • Müllerian malformations such as non-communicating rudimentary horn with uterus unicornis and Müllerian duct cysts (usually small, midline, cystic masses).
The Gartner’s ducts, also known as “mesonephric” or “Wolffian” ducts are vestigial in female newborns. They correspond to the ductus deferens and ejaculatory ducts in males and, if not stimulated by testosterone, they begin irreversibly regress before 13 weeks. Cystic dilatation of the ducts are most commonly seen in the lateral vaginal walls but may be also localized in broad ligaments and ovaries.

Hermann Treschow Gartner (born October 1785, on the island of Saint Thomas, Virgin Islands; died April 4, 1827), was a Danish surgeon and anatomist. His name is associated with the discovery and description of the ductus epoophori longitudinalis (1822), the duct that now bears his name - Gartner’s Duct (source: Wikipedia)

References

1. Tu T.T Lee, Jeanty P., ,online CME Pelvic cystic lesions, https://iame.com/online/pelvic_cystic_lesions/content.php‎
2. M. Dujardin, A. Schiettecatte, D. Verdries, J. de Mey: Cystic lesions of the female reproductive system: a review. JBR–BTR, 2010, 93: 56-61.
3. Currarino G. Single vaginal ectopic ureter and Gartner’s duct cyst with ipsilateral renal hypoplasia and dysplasia (or agenesis). J Urol 1982;128:988–993
4. Nussbaum Blask AR, Sanders RC, Gaerhart JP. Obstructed uterovaginal anomalies: demonstration with
sonography. I. Neonates and infants. Radiology 1991; 179:79–83
5. Kiechl-Kohlendorfer U. and al ,Diagnosing Neonatal Female Genital Anomalies Using Saline-Enhanced Sonography. AJR:177, November 2001
Back to case
Help Support TheFetus.net :