Answer to the last #DiagnosticDilemma
A) Hydrocolpos

Physical examination of a 1-day-old girl born by vaginal delivery at 36 weeks of gestation revealed a soft mass protruding from the external genitalia. The mass was noted to increase in size when the infant cried. There was no abdominal distention, and the physical examination was otherwise normal. She was able to pass urine and feces regularly, and renal function was normal. An ultrasound examination performed during the third trimester of pregnancy had revealed a pelvic mass in the fetus, but further follow-up investigations had not been performed before delivery.

Ultrasonography of the infant’s abdomen confirmed hydrocolpos, with vaginal distention, a normal uterus, and no urinary tract dilatation. Neonatal hydrocolpos is an accumulation of secretions caused by vaginal obstruction, usually related to an imperforate hymen. It is not always as large or as readily apparent on physical examination as it was in this case. The infant underwent a hymenal incision under general anesthesia on day 3, and the mass resolved. Follow-up ultrasonography performed after 2 months revealed a normal urinary tract and internal genitalia and no residual mass.
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