One-day-old female with abdominal and pelvic mass. There are likely 3 perineal orifices. A cystic mass extends from the pelvis into the abdomen and measures approximately 6.7 x 7.4 x 7.9 cm. The contents of the mass are bright on T1 and T2 weighted images, consistent with subacute blood products. There is a fluid-fluid level and layering debris in the dependent portion of the mass with lower signal intensity on the T1 and T2 weighted images, which likely reflects chronic blood products. The vagina has an upside down pear shape and is indented in the midline inferiorly with the right side slightly larger than the left. An obliquely oriented fine tubular structure arises from the inferior apex of the left side of the vagina and extends from the left superiorly to the right inferiorly approaching the perineum. The mass appears to compress the urinary bladder anteriorly in addition to the inferior vena cava posteriorly. The hemiazygos and azygos veins are dilated. The mass also obstructs the ureters with bilateral grade 3 hydronephrosis. Anterior to the superior portion of the left kidney is a fluid-filled structure measuring 2 cm in diameter, which most likely represents a duplicated ureter with an obstructed upper pole system.The uterus is located anterior to the mass in the midline and measures approximately 2.5 x 2.0 cm.Atelectasis is seen in both lung bases. There is extensive soft tissue edema. The liver, gallbladder and spleen are normal. The bowel is normal in caliber.
1. Obstructed vagina and uterus. There appears to be a longitudinal septum in the vagina with the right side larger than the left.2. Extrinsic obstruction of the ureters due to the mass with grade 3 hydronephrosis bilaterally. 3. Findings of a probable left duplicated ureter with an obstructed upper pole system.4. Extensive soft tissue edema.Please note that ultrasonography would be helpful in further evaluation of the anatomy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.