Hydronephrosis caused by imperforate hymen in an infant
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A 3-month-old female infant was admitted to hospital for frequent crying. Her parents were healthy, without significant family medical history. Abdominal ultrasound revealed mild right hydronephrosis and severe left hydronephrosis. The pelvic ultrasonography was performed after the conjecture that hydronephrosis might be caused by the lower ureter obstruction. It showed a large pear-shaped cystic mass between the bladder and the rectum with a size of 12.4 cm × 7.7 cm × 5.2 cm. The cystic mass presented as a funnel-shaped blind pouch at the distal end of the vagina with a thin membrane distended with fluid.

Transperineal high-resolution sonography detected the thickness of the membrane as 0.2 cm. No vascularity was demonstrated within the cystic lesion on color Doppler flow imaging (CDFI), and the bladder was empty. In addition, the hymen was found to bulge outwards when abdominal pressure was increased during crying, which was not clearly evident in the resting state. Therefore, based on these typical ultrasound characteristics and clinical signs, the diagnosis of imperforate hymen was made. It was believed that the cystic mass might cause pressure on the ureter, resulting in hydronephrosis, especially in the left kidney. There were no abnormal laboratory values.

On account of ultrasound diagnosis, the baby underwent hymenotomy with a cruciate incision to prevent future complications such as acute renal injury. The patient tolerated the procedure well and was discharged from the hospital on the fourth postoperative day. The patient was followed-up with abdominal sonography at the local hospital after 2 months, and the follow-up results showed a mild left hydronephrosis indicating improvement.