Arch Gynecol Obstet (2014) 290:1049–1050 DOI 10.1007/s00404-014-3426-y
LETTER TO THE EDITOR
An unusual complication of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome Tae-Hee Kim • Hae-Hyeog Lee • Dongwon Byun
Received: 8 August 2014 / Accepted: 12 August 2014 / Published online: 24 August 2014 Ó Springer-Verlag Berlin Heidelberg 2014
Sir, We read with interest the report by Zivkovic´ et al. [1] entitled ‘‘Unusual case of OHVIRA syndrome with complication’’. Mullerian duct anomalies are rare congenital female genital tract anomalies that are divided into seven classifications and subtypes. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is characterized mainly by uterus didelphys, septate uterus, an obstructed hemivagina, and renal agenesis. The most common complications associated with Mullerian anomalies include endometriosis, dysmenorrhea, cervix hematoma, abortion, and premature birth. The case reported by Zivkovic´ et al. [1] is a very rare complication of intrapartal rupture during delivery. We have also experienced very rare case of OHVIRA syndrome. A 35-year-old gravida 0 female was transferred to our institution for uterine myoma and uterine anomalies.
Pelvic examination revealed a large uterus, double cervix, and hard palpable mass in the left vagina wall. CT revealed a suspicious underlying hemivaginal obstruction, hematoma with calcification, left renal agenesis with uterus didelphys, and subserosal myomas (Fig. 1a). MRI revealed uterus didelphys with a left hemivaginal obstruction, a large adenomyotic cyst in the left cervix, and left renal agenesis (Fig. 1b). The calcified mass in our patient had formed secondary to old menstrual blood. Our patient was unaware of her calcified vaginal masses before CT or MRI examination. Classification of Mullerian duct anomalies depends mainly on fusion of the Mullerian ducts. Therefore, unclassified Mullerian duct anomalies or uncommon complications are found incidentally. Addition of our case of OHVIRA syndrome with vaginal calcified masses such as stones to cases of vaginal rupture during delivery will provide clinically useful information to obstetricians and other readers.
T.-H. Kim H.-H. Lee (&) Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeunggi 420-767, Republic of Korea e-mail: [email protected]; [email protected] D. Byun Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul 140-743, Republic of Korea
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Arch Gynecol Obstet (2014) 290:1049–1050
Fig. 1 a CT revealed a 4.2 9 4.0 cm mass with a complex echogenic area and a low-density mass with a high-density area in the left cervical area. b MRI shows a 4.2 9 4.0 cm mass with calcification and an internal heterogeneous signal intensity Acknowledgments This work was supported in part by the Soonchunhyang University Research Fund. Conflict of interest
The authors report no conflict of interest.
Reference 1. Zivkovic´ K, Prka M, Zivkovic´ N, Bucko A, Habek D (2014) Unusual case of OHVIRA syndrome with a single uterus,
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unrecognized before labor and followed by an intrapartal rupture of obstructed hemivagina. Arch Gynecol Obstet. doi:10.1007/ s00404-014-3339-9
LETTER TO THE EDITOR
An unusual complication of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome Tae-Hee Kim • Hae-Hyeog Lee • Dongwon Byun
Received: 8 August 2014 / Accepted: 12 August 2014 / Published online: 24 August 2014 Ó Springer-Verlag Berlin Heidelberg 2014
Sir, We read with interest the report by Zivkovic´ et al. [1] entitled ‘‘Unusual case of OHVIRA syndrome with complication’’. Mullerian duct anomalies are rare congenital female genital tract anomalies that are divided into seven classifications and subtypes. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is characterized mainly by uterus didelphys, septate uterus, an obstructed hemivagina, and renal agenesis. The most common complications associated with Mullerian anomalies include endometriosis, dysmenorrhea, cervix hematoma, abortion, and premature birth. The case reported by Zivkovic´ et al. [1] is a very rare complication of intrapartal rupture during delivery. We have also experienced very rare case of OHVIRA syndrome. A 35-year-old gravida 0 female was transferred to our institution for uterine myoma and uterine anomalies.
Pelvic examination revealed a large uterus, double cervix, and hard palpable mass in the left vagina wall. CT revealed a suspicious underlying hemivaginal obstruction, hematoma with calcification, left renal agenesis with uterus didelphys, and subserosal myomas (Fig. 1a). MRI revealed uterus didelphys with a left hemivaginal obstruction, a large adenomyotic cyst in the left cervix, and left renal agenesis (Fig. 1b). The calcified mass in our patient had formed secondary to old menstrual blood. Our patient was unaware of her calcified vaginal masses before CT or MRI examination. Classification of Mullerian duct anomalies depends mainly on fusion of the Mullerian ducts. Therefore, unclassified Mullerian duct anomalies or uncommon complications are found incidentally. Addition of our case of OHVIRA syndrome with vaginal calcified masses such as stones to cases of vaginal rupture during delivery will provide clinically useful information to obstetricians and other readers.
T.-H. Kim H.-H. Lee (&) Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeunggi 420-767, Republic of Korea e-mail: [email protected]; [email protected] D. Byun Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul 140-743, Republic of Korea
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Arch Gynecol Obstet (2014) 290:1049–1050
Fig. 1 a CT revealed a 4.2 9 4.0 cm mass with a complex echogenic area and a low-density mass with a high-density area in the left cervical area. b MRI shows a 4.2 9 4.0 cm mass with calcification and an internal heterogeneous signal intensity Acknowledgments This work was supported in part by the Soonchunhyang University Research Fund. Conflict of interest
The authors report no conflict of interest.
Reference 1. Zivkovic´ K, Prka M, Zivkovic´ N, Bucko A, Habek D (2014) Unusual case of OHVIRA syndrome with a single uterus,
123
unrecognized before labor and followed by an intrapartal rupture of obstructed hemivagina. Arch Gynecol Obstet. doi:10.1007/ s00404-014-3339-9
