Absence of vagina and hypoplasia of the urethra and ectopia of the ureter.

A 16-year-old Japanese girl was admitted for evaluation of complaints of primary amenorrhea, cyclic lower abdominal pain, and urinary incontinence. Her vaginal introitus appeared rudimentary with a depth of 0.5 cm and hypoplasia of the hymenal ring. A hypoplastic urethra (diameter: 1 cm; length: 0.5 cm) and 1 of 2 right ectopic ureters opened into the introitus. Transabdominal ultrasonography demonstrated fluid distending the uterus, the proximal 1/3 of the vagina, and the pouch of Douglas. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of hematometrocolpos and fluid collection in the pouch of Douglas. These associated anomalies can be due to faulty growth of the urogenital sinus. In addition to the transabdominal ultrasonography and CT, MRI was useful in the diagnosis and evaluation of vaginal agenesis.