55-year-old female with history of vaginal cancer. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: There is air within the bladder.LYMPH NODES: Shotty inguinal lymph nodes are decreased from prior.BOWEL, MESENTERY: There is tethering of the sigmoid colon to the vaginal cuff. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Vaginal mass has significantly decreased in size. Irregular mucosal thickening and mild enhancement of the right lateral vagina extending into the posterior aspect of the bladder (image 299 of series 1004). There is also improved appearance of parametrial invasion. There is air within the vaginal cuff.Ventral abdominal surgical scar.
Interval significant decrease in size of right vaginal mass. Given the bladder involvement and air within the bladder, in the absence of recent instrumention, a vesicovaginal fistula is suspected.