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So we'll start with our first case.

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This is a 19-year-old patient who

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came in with primary amenorrhea.

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An outside ultrasound, which I don't have,

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showed a "small uterus, no ovaries."

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She was 46XX as well, just to confirm.

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So we go to the MRI right here.

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We have a T2-weighted image.

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We have a small field of view and you

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can see there's a left ovary here, fairly

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normal size, lots of normal follicles.

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On the right as well, we have

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a normal physiologic dominant

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follicle and lots of tiny follicles.

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You have some tissue down here, and

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then we get into the bladder, right?

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Bladder's right here, rectum back here.

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So vagina should be somewhere right around here.

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There's your vagina, urethra,

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vagina, rectum right here.

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We're really not seeing any significant tissue.

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We don't see a uterus.

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Axial plane imaging of the uterus

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is often very difficult to see.

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So you're going to rely on your other

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sequences, your other fields of view.

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So here is your sagittal sequence.

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So as we scroll through, again, you have

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your bladder here, your rectum here,

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kind of get them all in one plane right here.

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Again, rectum here, anal canal right here,

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bladder, urethra will be right in here.

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That means this is the vagina right here, and we

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just have this little bit of tissue right here.

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And you can scroll through it to see, do you

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think there's a very, very atrophic uterus

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right here, or is this just all vaginal tissue?

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You could have potentially a cervix,

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so you're gonna look for an endometrium.

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If you can see any of that or just the quality

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of the tissue right here, and it all looks

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very similar to the rest of the vaginal tissue.

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All this sort of like mildly

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T2 bright structure right here.

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We don't see anything that shows a

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normal uterus or cervix right here.

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You can also confirm on your coronal image.

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So we go backwards with your bladder right here.

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Vagina should be somewhere right around here,

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and this is all of your tissue right here.

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And now we're all the way back into the rectum.

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Again, some free fluid back

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here, which is physiologic.

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But here's your vaginal tissue right here.

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So this is all just vaginal tissue.

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Almost looks like a hysterectomy in that sense

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where you have this vaginal tissue there.

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So this is considered a hypoplasia right here.

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So we see hypoplastic vaginal tissue.

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We see lots of parametrial vessels.

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That's what all of these are right here.

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And we see our normal ovaries.

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In her particular case, we did do some

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imaging on the T2 of the abdomen to see

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if she had kidneys, and you can see here

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that she does have two kidneys normally

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positioned and look pretty normal.

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No anomalies there.

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So what happens here, this can occur

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because of an interruption of mullerian

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duct development very early in development.

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You can get a complete aplasia, or you

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can get a hypoplasia, and that can include

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the vagina, the cervix, or the uterus.

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So in this case, our patient has

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a vagina, but no cervix or uterus.

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So obviously this patient will not

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be able to carry a pregnancy to term.

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She could have a surrogate potentially because

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she does have ovaries, so she can have a

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surrogate, but there won't be a pregnancy.

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There's nothing you can do about that.

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So in cases like this too, beyond

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that, the goal is also to enable sexual

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function if the vagina itself is affected.

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And in her case, it is not.