EURORAD ESR

Case 15268

Early CT after vaginal hysterectomy: normal or abnormal?

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 80 year(s)
 
 
  • Figure 1
    Contrast-enhanced multidetector CT (4 days after vaginal hysterectomy)
     

    Sagittal (a), coronal (b) and axial (c,d) images showed moderately distended vagina with intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow). Note...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Acute;

    The moderately distended vagina showed intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow). No abscess or blood collections abutting the vagina.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Acute;

    The moderately distended vagina showed intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Acute;

    The moderately distended vagina showed intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow). Note mild postoperative oedema (*) of surrounding fat...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Acute;
     
     
  • Figure 2
    Usual contrast-enhanced CT appearance after uncomplicated hysterectomy
     

    Sagittal (a) and axial (b) images showing usual band-shaped appearance of the vagina (arrows), slightly retracted cranially with non-thickened walls, thin enhancing mucosa. Note postsurgical absence of uterus, lack of...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Acute;

    Sagittal (a) and axial (b) images showing usual band-shaped appearance of the vagina (arrows), slightly retracted cranially with non-thickened walls, thin enhancing mucosa. Note postsurgical absence of uterus, lack of...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Surgery; Special Focus: Acute;
     
     
  • Figure 3
    Usual MRI appearance after hysterectomy
     

    Sagittal (a) and axial (b) T2-weighted images showing usual band-shaped appearance of the vagina (arrows), with non-thickened walls and normal low signal intensity. Note postsurgical absence of uterus.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Surgery; Special Focus: Acute;

    Sagittal (a) and axial (b) T2-weighted images showing usual band-shaped appearance of the vagina (arrows), with non-thickened walls and normal low signal intensity. Note postsurgical absence of uterus.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Surgery; Special Focus: Acute;

    Axial fat-suppressed T1-weighted image after iv gadolinium contrast showing usual band-shaped appearance of the vagina (arrows), with non-thickened walls and thin enhancing mucosa.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Surgery; Special Focus: Acute;
     
     
  • Figure 4
    Usual CT appearance of vaginal vault haematoma (VVH) after hysterectomy
     

    Sagittal (a) and axial (b) precontrast images showing usual appearance of self-limiting VVH after vaginal hysterectomy as hyperattenuating swelling (*) located just above the closed vaginal dome (arrow in b).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Sagittal (a) and axial (b) precontrast images showing usual appearance of self-limiting VVH after vaginal hysterectomy as hyperattenuating swelling (*) located just above the closed vaginal dome (arrow in b).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 5
    CT appearance of a surgical site infection (SSI) after hysterectomy
     

    Sagittal (a), coronal (b) and axial (c) post-contrast CT images showing an abscess collection (*) with peripheral enhancement (arrowheads) extending upwards from the closed vaginal dome (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Sagittal (a), coronal (b) and axial (c) post-contrast CT images showing an abscess collection (*) with peripheral enhancement (arrowheads) extending upwards from the closed vaginal dome (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Sagittal (a), coronal (b) and axial (c) post-contrast CT images showing an abscess collection (*) with peripheral enhancement (arrowheads) extending upwards from the closed vaginal dome (arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 6
    Usual CT appearance of lymphocoele after hysterectomy
     

    Axial (a) and coronal (b) post-contrast images showing usual appearance of lymphocoele (*) as demarcated fluid-filled structure abutting the external iliac vessels, adjacent to a surgical clip (thin arrow in b).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Usual appearance of lymphocele (*) as demarcated fluid-filled structure abutting the external iliac vessels, adjacent to a surgical clip (thin arrow in b) and clearly separated from closed vaginal dome (arrow in b).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 7
    Usual CT appearance of urinoma after hysterectomy
     

    Portal-venous phase image showed mixed-attenuation collection (*) above closed vaginal dome, with a fluid-attenuation dependent portion (arrowhead). Note prophylactic bilateral ureteral stents (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Transplantation;

    On excretory-phase acquisition the most dependent portion (arrowhead) enhanced similarly to the bladder lumen, consistent with urinoma. Note closed vaginal dome (arrow), bilateral ureteral stents (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Further delayed acquisition in the prone position confirmed opacified urinoma (arrowhead), which developed despite prophylactic ureteral stents (thin arrows). Note Foley catheter (thick arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
Sagittal (a), coronal (b) and axial (c,d) images showed moderately distended vagina with intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow). Note postsurgical absence of uterus.
 
The moderately distended vagina showed intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow). No abscess or blood collections abutting the vagina.
 
The moderately distended vagina showed intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow).
 
The moderately distended vagina showed intraluminal fluid, circumferential mural thickening (arrows) and prominent uniform mucosal hyperenhancement (thin arrow). Note mild postoperative oedema (*) of surrounding fat planes.
 
Sagittal (a) and axial (b) images showing usual band-shaped appearance of the vagina (arrows), slightly retracted cranially with non-thickened walls, thin enhancing mucosa. Note postsurgical absence of uterus, lack of abnormal collections at vaginal vault.
 
Sagittal (a) and axial (b) images showing usual band-shaped appearance of the vagina (arrows), slightly retracted cranially with non-thickened walls, thin enhancing mucosa. Note postsurgical absence of uterus, lack of abnormal collections at vaginal vault.
 
Sagittal (a) and axial (b) T2-weighted images showing usual band-shaped appearance of the vagina (arrows), with non-thickened walls and normal low signal intensity. Note postsurgical absence of uterus.
 
Sagittal (a) and axial (b) T2-weighted images showing usual band-shaped appearance of the vagina (arrows), with non-thickened walls and normal low signal intensity. Note postsurgical absence of uterus.
 
Axial fat-suppressed T1-weighted image after iv gadolinium contrast showing usual band-shaped appearance of the vagina (arrows), with non-thickened walls and thin enhancing mucosa.
 
Sagittal (a) and axial (b) precontrast images showing usual appearance of self-limiting VVH after vaginal hysterectomy as hyperattenuating swelling (*) located just above the closed vaginal dome (arrow in b).
 
Sagittal (a) and axial (b) precontrast images showing usual appearance of self-limiting VVH after vaginal hysterectomy as hyperattenuating swelling (*) located just above the closed vaginal dome (arrow in b).
 
Sagittal (a), coronal (b) and axial (c) post-contrast CT images showing an abscess collection (*) with peripheral enhancement (arrowheads) extending upwards from the closed vaginal dome (arrows).
 
Sagittal (a), coronal (b) and axial (c) post-contrast CT images showing an abscess collection (*) with peripheral enhancement (arrowheads) extending upwards from the closed vaginal dome (arrows).
 
Sagittal (a), coronal (b) and axial (c) post-contrast CT images showing an abscess collection (*) with peripheral enhancement (arrowheads) extending upwards from the closed vaginal dome (arrows).
 
Axial (a) and coronal (b) post-contrast images showing usual appearance of lymphocoele (*) as demarcated fluid-filled structure abutting the external iliac vessels, adjacent to a surgical clip (thin arrow in b).
 
Usual appearance of lymphocele (*) as demarcated fluid-filled structure abutting the external iliac vessels, adjacent to a surgical clip (thin arrow in b) and clearly separated from closed vaginal dome (arrow in b).
 
Portal-venous phase image showed mixed-attenuation collection (*) above closed vaginal dome, with a fluid-attenuation dependent portion (arrowhead). Note prophylactic bilateral ureteral stents (thin arrows).
 
On excretory-phase acquisition the most dependent portion (arrowhead) enhanced similarly to the bladder lumen, consistent with urinoma. Note closed vaginal dome (arrow), bilateral ureteral stents (thin arrows).
 
Further delayed acquisition in the prone position confirmed opacified urinoma (arrowhead), which developed despite prophylactic ureteral stents (thin arrows). Note Foley catheter (thick arrow).
 
 
 
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