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E1444. Don’t Get Stuck! Female Reproductive Tract Obstruction: Causes and Mimics
Authors
  1. Adam Jokhio; Queen's University
  2. Andrew Chung; Queen's University
  3. Olga Brook; Beth Israel Deaconess Medical Center
Background
Obstruction of the female reproductive tract can be a challenging diagnosis. Clinical symptoms may be nonspecific; including pelvic pain, dysmenorrhea, or a palpable mass (1,2). At first line imaging with ultrasound, distortion of the normal anatomy secondary to obstruction may make anatomic localization challenging. Difficulty identifying normal anatomic landmarks as well as the extent of obstruction may result in initial misdiagnosis – mimicking a cystic mass, full urinary bladder, or other pathology – and delaying appropriate diagnosis and treatment (1,3). Through this exhibit, we will review the causes of female reproductive tract obstruction. The imaging features of female reproductive tract obstruction and its mimics will be presented through a case-based approach.

Educational Goals / Teaching Points
The goals of this exhibit are to review the embryology, anatomy, and physiology of the female reproductive tract as they pertain to the pathogenesis of obstruction; provide a case-based review of congenital and acquired causes of female reproductive tract obstruction, emphasizing key imaging features, particularly at magnetic resonance imaging (MRI); and review pitfalls when imaging for female reproductive tract obstruction, including imaging mimics.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit provides insights for imaging and deciphering female reproductive tract obstruction, including how to localize the site of obstruction. This includes a review of female reproductive tract anatomy, in particular the embryology which may result in congenital anomalies predisposing to obstruction. Physiologic changes with age, disease, or treatment which lead to acquired obstruction of the female reproductive tract will also be summarized. We describe appropriate technique for imaging female reproductive tract obstruction, with emphasis on MRI considerations. This case-based review provides a conceptual framework for imaging reproductive tract obstruction, subdivided by affected anatomy: hydro/hematocolpos – simple (imperforate hymen, vaginal septum, vaginal atresia) and complex (OHVIRA/Herlyn-Werner-Wunderlich syndrome) causes of vaginal obstruction; hydro/hematometra – causes of cervical stenosis, including physiologic (menopause), inflammatory (radiotherapy, endometritis), and malignant (cervical carcinoma, secondary invasion from bladder/rectal malignancies); hydro/hematosalpinx – imaging of pelvic inflammatory disease; imaging features of endometriosis and pathogenesis; as well as imaging mimics – cystic pelvic neoplasms, fibroid degeneration, and uterine sarcomas.

Conclusion
Obstruction of the female reproductive tract encompasses a wide array of pathologies, which may be congenital or acquired. Diagnosis can be challenging due to nonspecific clinical presentation and distortion of normal anatomic landmarks. The radiologist may play a key role in diagnosis, and familiarity with proper imaging technique and common imaging appearances for causes of female reproductive tract obstruction is critical.