US of the Pediatric Female Pelvis: A Clinical Perspective1
Laurent Garel, MD,
Josée Dubois, MD,
Andrée Grignon, MD,
Denis Filiatrault, MD and
Guy Van Vliet, MD
1 From the Departments of Medical Imaging (L.G., J.D., A.G., D.F.) and Endocrinology (G.V.V.), Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montreal, Quebec, Canada H3T 1C5; and the Departments of Radiology (L.G., J.D., A.G., D.F.) and Endocrinology (G.V.V.), University of Montreal. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received March 28, 2001; revision requested April 26 and received May 28; accepted May 29. Address correspondence to L.G. (e-mail: laurent_garel@ssss.gouv.qc.ca).
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Figure 1. Neonatal uterus. Longitudinal US scan shows a prominent cervix (arrows) and a visible endometrium (arrowheads). Some fluid (F) is seen within the vagina.
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Figure 2a. Prepubertal uterus. (a) Longitudinal US scan obtained in a 5-year-old girl shows a tubular uterus; the anteroposterior diameter is 6 mm. (b) Longitudinal US scan obtained in a 6-year-old girl shows the endometrial lining as a thin echogenic line (arrow).
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Figure 2b. Prepubertal uterus. (a) Longitudinal US scan obtained in a 5-year-old girl shows a tubular uterus; the anteroposterior diameter is 6 mm. (b) Longitudinal US scan obtained in a 6-year-old girl shows the endometrial lining as a thin echogenic line (arrow).
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Figure 3. Postpubertal uterus in a 13-year-old girl. Longitudinal US scan shows that the fundus is larger than the cervix; the endometrium is well seen.
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Figure 4a. Effect of overfilling of the bladder on uterine shape in a 12-year-old girl. (a) Longitudinal US scan shows an overfilled bladder compressing the uterus, making the fundal prominence less apparent than in b. (b) Longitudinal US scan obtained after partial emptying of the bladder clearly shows that the fundus is thicker than the cervix.
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Figure 4b. Effect of overfilling of the bladder on uterine shape in a 12-year-old girl. (a) Longitudinal US scan shows an overfilled bladder compressing the uterus, making the fundal prominence less apparent than in b. (b) Longitudinal US scan obtained after partial emptying of the bladder clearly shows that the fundus is thicker than the cervix.
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Figure 5a. Microcystic follicles. (a) Transverse US scan obtained in a 1-month-old girl shows normal ovaries (arrows) with visible follicles. The ovarian volume is 1 cm3. (b) Transverse US scan obtained in a 6-year-old girl shows normal ovaries (arrows) with visible follicles. The ovarian volume is 2 cm3.
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Figure 5b. Microcystic follicles. (a) Transverse US scan obtained in a 1-month-old girl shows normal ovaries (arrows) with visible follicles. The ovarian volume is 1 cm3. (b) Transverse US scan obtained in a 6-year-old girl shows normal ovaries (arrows) with visible follicles. The ovarian volume is 2 cm3.
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Figure 6a. US assessment of hormonal status in an 8-year-old girl (bone age = 11 years). (a) Longitudinal US scan shows that the uterus has a postpubertal shape. The fundus is 1.75 cm in anteroposterior diameter. (b) Transverse US scan shows that the ovaries are not indicative of the postpubertal status, since they have a similar appearance with visible follicles at all ages. The difference is mainly in the size of the ovary.
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Figure 6b. US assessment of hormonal status in an 8-year-old girl (bone age = 11 years). (a) Longitudinal US scan shows that the uterus has a postpubertal shape. The fundus is 1.75 cm in anteroposterior diameter. (b) Transverse US scan shows that the ovaries are not indicative of the postpubertal status, since they have a similar appearance with visible follicles at all ages. The difference is mainly in the size of the ovary.
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Figure 7. Premature thelarche in an 8-year-old girl (bone age = 8 years). Longitudinal US scan shows a prepubertal uterus (anteroposterior thickness = 5 mm).
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Figure 8. Rhabdomyosarcoma in an 18-month-old girl with vaginal bleeding. Longitudinal US scan of the pelvis clearly shows a large, solid mass within the vagina (arrow). B = bladder.
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Figure 10a. Peripheral precocious puberty in an 11-month-old girl. (a) Longitudinal US scan shows an obviously stimulated uterus (between cursors). (b) Transverse US scan of the cystic left ovary shows two follicles (arrows) within the main cyst (the daughter cyst sign).
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Figure 10b. Peripheral precocious puberty in an 11-month-old girl. (a) Longitudinal US scan shows an obviously stimulated uterus (between cursors). (b) Transverse US scan of the cystic left ovary shows two follicles (arrows) within the main cyst (the daughter cyst sign).
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Figure 11a. Turner syndrome in a 12-year-old girl. (a) Longitudinal US scan shows a minute uterus (arrow). (b) Transverse US scan shows no visible ovarian tissue.
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Figure 11b. Turner syndrome in a 12-year-old girl. (a) Longitudinal US scan shows a minute uterus (arrow). (b) Transverse US scan shows no visible ovarian tissue.
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Figure 12a. Embryologic development of the uterus and vagina. (a) Diagrams show that both müllerian ducts (red area) fuse on the midline to form the uterus. The proximal part of the duct gives rise to the fallopian tube. The wolffian ducts (green areas) regress. The distal remnant of the wolffian duct forms the Gartner duct. (b) Diagrams show that the uterovaginal canal (red area) reaches the urogenital sinus (pink area) (1). The vaginal plate develops (2), proliferates (3), and undergoes canalization (4). The vagina is formed by both the müllerian ducts and the urogenital sinus (5).
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Figure 12b. Embryologic development of the uterus and vagina. (a) Diagrams show that both müllerian ducts (red area) fuse on the midline to form the uterus. The proximal part of the duct gives rise to the fallopian tube. The wolffian ducts (green areas) regress. The distal remnant of the wolffian duct forms the Gartner duct. (b) Diagrams show that the uterovaginal canal (red area) reaches the urogenital sinus (pink area) (1). The vaginal plate develops (2), proliferates (3), and undergoes canalization (4). The vagina is formed by both the müllerian ducts and the urogenital sinus (5).
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Figure 13a. Müllerian agenesis in a 17-year-old girl with primary amenorrhea and normal secondary sexual features. (a) Longitudinal US scan of the pelvis shows a rudimentary uterus (between cursors). (b) Longitudinal US scan shows a normal right ovary (arrow). The left ovary was also normal.
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Figure 13b. Müllerian agenesis in a 17-year-old girl with primary amenorrhea and normal secondary sexual features. (a) Longitudinal US scan of the pelvis shows a rudimentary uterus (between cursors). (b) Longitudinal US scan shows a normal right ovary (arrow). The left ovary was also normal.
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Figure 14a. Neonatal hematometrocolpos. (a) Transverse US scan of a third-trimester fetus shows a huge cystic mass (C) with a fluid-debris level (arrow). The mass fills almost the entire abdomen. (b) Longitudinal US scan obtained in the same patient as a newborn shows the mass (C), which still has a fluid-debris level (arrow). (c) Radiograph obtained with contrast material administered through the draining catheter shows evidence of distal vaginal atresia (straight arrow) and reflux of contrast material within the uterine cavity (curved arrow).
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Figure 14b. Neonatal hematometrocolpos. (a) Transverse US scan of a third-trimester fetus shows a huge cystic mass (C) with a fluid-debris level (arrow). The mass fills almost the entire abdomen. (b) Longitudinal US scan obtained in the same patient as a newborn shows the mass (C), which still has a fluid-debris level (arrow). (c) Radiograph obtained with contrast material administered through the draining catheter shows evidence of distal vaginal atresia (straight arrow) and reflux of contrast material within the uterine cavity (curved arrow).
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Figure 14c. Neonatal hematometrocolpos. (a) Transverse US scan of a third-trimester fetus shows a huge cystic mass (C) with a fluid-debris level (arrow). The mass fills almost the entire abdomen. (b) Longitudinal US scan obtained in the same patient as a newborn shows the mass (C), which still has a fluid-debris level (arrow). (c) Radiograph obtained with contrast material administered through the draining catheter shows evidence of distal vaginal atresia (straight arrow) and reflux of contrast material within the uterine cavity (curved arrow).
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Figure 15. Hematometrocolpos due to an imperforate hymen in a 14-year-old girl with cyclic pelvic pain and primary amenorrhea. Longitudinal US scan shows a thin-walled, distended vagina (V) and the uterine cavity (U) with its thick myometrium.
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Figure 16a. Duplex uterus with an obstructed hemivagina in a 12-year-old girl. (a) Transverse US scan shows a normal left uterus (arrow) and a dilated right uterus (U). (b) Longitudinal US scan obtained along the obstructed side shows a distended vagina (V) and the dilated uterine cavity (U). The right kidney was absent. (c) Transverse US scan shows an endometrial cyst (C) adjacent to the ovary and the dilated fallopian tube.
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Figure 16b. Duplex uterus with an obstructed hemivagina in a 12-year-old girl. (a) Transverse US scan shows a normal left uterus (arrow) and a dilated right uterus (U). (b) Longitudinal US scan obtained along the obstructed side shows a distended vagina (V) and the dilated uterine cavity (U). The right kidney was absent. (c) Transverse US scan shows an endometrial cyst (C) adjacent to the ovary and the dilated fallopian tube.
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Figure 16c. Duplex uterus with an obstructed hemivagina in a 12-year-old girl. (a) Transverse US scan shows a normal left uterus (arrow) and a dilated right uterus (U). (b) Longitudinal US scan obtained along the obstructed side shows a distended vagina (V) and the dilated uterine cavity (U). The right kidney was absent. (c) Transverse US scan shows an endometrial cyst (C) adjacent to the ovary and the dilated fallopian tube.
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Figure 17. Immature ovarian teratoma in an 8-year-old girl. Longitudinal US scan shows a septated cystic mass with mural nodules.
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Figure 18. Mature ovarian teratoma in a 2-year-old girl. Transverse US scan shows a solid retrovesical mass with a shadowing echogenic focus of calcium (arrow).
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Figure 19. Torsion of a normal ovary in a 10-year-old girl with severe acute pelvic pain. Transverse US scan shows a markedly enlarged right ovary with peripheral follicles (arrows).
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Figure 20a. Ruptured hemorrhagic ovarian cyst. (a) Longitudinal US scan of the uterus shows a prominent (midcycle) endometrium (arrow) and free peritoneal fluid (F). (b) Longitudinal US scan of the left ovary shows a complex adnexal mass adjacent to the ovarian parenchyma. Good through transmission is suggestive of the diagnosis initially.
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Figure 20b. Ruptured hemorrhagic ovarian cyst. (a) Longitudinal US scan of the uterus shows a prominent (midcycle) endometrium (arrow) and free peritoneal fluid (F). (b) Longitudinal US scan of the left ovary shows a complex adnexal mass adjacent to the ovarian parenchyma. Good through transmission is suggestive of the diagnosis initially.
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Figure 21. Sexual differentiation in the fetus. Left: Diagram shows that adequate male differentiation needs the activity of two fetal testicular hormones, antimüllerian hormone and testosterone. The former contributes to regression of the müllerian ducts; the latter contributes to masculinization of the wolffian ducts and the urogenital sinus after reduction of dihydrotestosterone (DHT). H = hormone. Right: Diagram shows that the process is autonomous in the female. The müllerian ducts persist in the absence of antimüllerian hormone, and the wolffian ducts regress in the absence of testosterone.
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Figure 22a. Ambiguous genitalia in a newborn with congenital adrenal hyperplasia. (a) Longitudinal US scan shows a normal uterus (arrow). (b) Lateral image from genitography shows urethrovaginal confluence (solid arrow) and partial opacification of the uterine cavity (open arrow). B = bladder, V = vagina.
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Figure 22b. Ambiguous genitalia in a newborn with congenital adrenal hyperplasia. (a) Longitudinal US scan shows a normal uterus (arrow). (b) Lateral image from genitography shows urethrovaginal confluence (solid arrow) and partial opacification of the uterine cavity (open arrow). B = bladder, V = vagina.
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Figure 23a. Ambiguous genitalia in a newborn with true hermaphroditism. (a) Longitudinal US scan of the inguinal region shows a testicular echostructure (between cursors). (b) Longitudinal US scan of the pelvis shows a uterus (arrow).
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Figure 23b. Ambiguous genitalia in a newborn with true hermaphroditism. (a) Longitudinal US scan of the inguinal region shows a testicular echostructure (between cursors). (b) Longitudinal US scan of the pelvis shows a uterus (arrow).
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Copyright © 2001 by the Radiological Society of North America.
-year-old girl. (a) Longitudinal US scan obtained for assessment of urinary tract infection at 7 months of age shows a prepubertal uterus (arrows). Note the visible endometrium (arrowheads). (b) Longitudinal US scan of the uterus (U) obtained at 5
