Mayer-Rokitansky-Kuster-Hauser syndrome diagnosed by magnetic resonance imaging in a 15-year-old girl.

STUDY OBJECTIVE: Mayer-Rokitansky-Kuster-Hauser syndrome diagnosed by magnetic resonance imaging (MRI) in a 15-year-old girl with primary amenorrhea is reported. DESIGN: The presentation, MRI, and the subsequent evaluation and treatment of an adolescent female patient with Rokitansky syndrome are described. Correlation is made with previous clinical, pathologic, and imaging reports in the literature. SETTING: An adolescent girl with primary amenorrhea was referred to our institution for completion of her diagnostic work-up. Previous limited evaluations suggested the presence of anomalies of the genitourinary tract. Further delineation of the suspected congenital defects was necessary. PARTICIPANT: The 15-year-old female patient was evaluated by the gynecology service. Diagnostic radiology and pediatric urology were consulted. INTERVENTIONS: MRI, physical examination under anesthesia, and cystoscopy were performed. After initial nonoperative treatment, the patient underwent hysterectomy and sigmoid vaginoplasty. MAIN OUTCOME MEASURES: The patient's primary amenorrhea was explained. Mayer-Rokitansky-Kuster-Hauser syndrome was diagnosed. Vaginal agenesis and widely separated rudimentary uterine horns were well shown by the MRI. Associated skeletal anomalies were noted. A treatment plan was initiated based on a good understanding of the anatomic defects. RESULTS: The MRI and physical examination firmly established the diagnosis. The patient was counseled and managed conservatively at first. Hysterectomy and vaginoplasty were subsequently performed. CONCLUSIONS: Mayer-Rokitansky-Kuster-Hauser syndrome is an unusual müllerian-duct anomaly that is a cause of primary amenorrhea. It can be confidently and noninvasively diagnosed with MRI. The MRI demonstration of vaginal, cervical, and uterine morphology contributes significantly to treatment planning and patient management.

Scrotal cystocele detected by sonography.

We report two cases of scrotal cystocele. In patients suspected of having a scrotal cystocele, we believe that ultrasonography is the initial examination of choice. Emptying of a scrotal cystocele with voiding is an important diagnostic feature. Failure to show a direct communication between the bladder and scrotal cystocele with ultrasonography should not exclude the diagnosis. Scrotal cystocele should be considered in the differential diagnosis of the fluidfilled scrotum. The preoperative detection of massive inguinoscrotal bladder herniation is important to avoid bladder injury during herniorrhaphy.

Detection of occult esophageal narrowing with a barium tablet during chest radiography.

Dysphagia is a delayed symptom of esophageal constriction and often appears after the luminal diameter is reduced to less than 10 mm. Earlier diagnosis of benign or malignant strictures while clinically silent would be desirable; hence we investigated the detectability of occult esophageal lesions with the aid of an ingested barium tablet during routine chest radiography. We prospectively examined 300 patients older than 40 years, who were referred for chest films because of indications unrelated to the upper gastrointestinal tract. Each patient was instructed to swallow a 12.5-mm barium tablet with 100 mL of water immediately prior to the exposure of posteroanterior and lateral chest films. Radiographs of 17 patients (5.6%) revealed intraesophageal retention of the tablet, and their prompt evaluation with double-contrast esophagrams confirmed various structural or functional abnormalities in 15 patients. Therefore, the oral administration of a barium tablet during routine chest radiography is a simple efficacious method to assess esophageal patency and detect occult narrowings from structural or functional causes.

Ultrasound findings following failed, clinically directed thoracenteses.

We prospectively examined 26 patients who were referred for ultrasound-guided thoracentesis, following at least one unsuccessful, clinically guided attempt. Sonographically guided thoracentesis was successful in obtaining fluid in 88% of patients. In addition, ultrasonography proved useful in suggesting or defining the cause for the initial unsuccessful attempt. Patients who have undergone an unsuccessful clinically guided thoracentesis and are referred for sonographic assistance represent a selected group who may have complicating factors not typically present during routine thoracentesis. Awareness of these potential complicating factors may facilitate the performance of ultrasound-guided thoracenteses.