1. To provide an overview of congenital gynecologic anomalies that may present with acute symptoms. 2. Evaluate the role of imaging in the teenage girl with pelvic pain. 3. Review the imaging characteristics of pediatric uterine and ovarian tumors.
Knowledge of the embryology of the genital tract and physiologic features of puberty is necessary in investigating emergency cases of pelvic pain. US plays a central role in imaging pediatric gynecologic emergencies with CT/MR useful adjuncts in the evaluation of pelvic masses.
Most cases of hydrometrocolpos in the neonate are associated with a urogenital sinus or cloacal malformation. Congenital uterovaginal obstructions appear as a cystic mass with debris level. Teenagers with obstructive uterovaginal anomalies present with amenorrhea and cyclic pain. US can differentiate hemato(metro)colpos due to imperforate hymen or transverse vaginal septum from the rare case of hematometra due to cervical dysgenesis. MR is useful for more complex urogenital anomaly assessment.
Uterine and ovarian tumors are rare in pediatrics. Vaginal botyroides - rhabdomyosarcomas appear as a large, solid, heterogeneous or hypoechoic mass. MR is useful for staging. Pediatric ovarian masses consist of functional cysts in approximately 60% and neoplasms in 40% of cases. 2/3 of ovarian neoplasms are benign mature teratomas, 1/3 are malignant. Ovarian malignancies in children are germ cell tumors (60%–75%) , epithelial tumors (10%–20%), and stromal tumors (10%). 30% of teratomas undergo torsion and are bilateral in 10%. US can show mural nodules (55%) and echogenic foci with shadowing (44% ).
Torsion of the normal ovary is due to excessive mobility. The involved ovary appears enlarged at US with multiple follicles at the periphery- absence or presence of flow by Doppler is not reliable diagnostic criterion.
Pelvic inflammatory disease is the most common cause of acute pelvic pain and can present with a surgical abdomen, mimicking appendicitis or perforation. Acute complications include tuboovarian complex / abscess
Bulas, D,
Gynecologic Emergencies in Children. Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL.
http://archive.rsna.org/2006/4404883.html
