Hydrocolpos or Hematocolpos

AJR 2012; 198:W324 0361–803X/12/1983–W324 © American Roentgen Ray Society Hydrocolpos or Hematocolpos? We congratulate Phillips et al. [1] on their instructive article in the May 2011 issue of the AJR, which highlights the important causes of lower abdomen pain in children, many of which are easily overlooked by clinicians and radiologists alike. Scenario 3 related the history of a 5-yearold girl with lower abdomen pain and was accompanied by two images from a pelvic ultrasound examination (Fig. 5 in the article). The authors described a fluid-distended vagina and diagnosed a hydrocolpos. In reviewing the relevant images, we agree that the vagina is distended with debris-laden fluid; however, the authors fail to point out that the uterus in Figure 5B is pubertal in configuration, with an echo-bright endometrial stripe. Such an appearance can only be secondary to stimulation by estrogen. The normal (nonneonatal) prepubertal uterus is small (less than 3–4 cm in length) with the fundus narrower than the cervix and no evidence of an endometrial bright stripe. If this image is indeed that of a 5-yearold girl, then further investigation for an endogenous or exogenous source of estrogen needs to be instituted; a hormone-secreting neoplasm is a possibility. Recognition of an ageappropriate uterus is vital for all who perform and interpret female pelvic imaging. We believe the images presented are more in keeping with an adolescent girl with primary amenorrhea and a diagnosis of hematocolpos. Anne Paterson Susan C. Gowdy Louise E. Sweeney Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, United Kingdom