Original Study| Volume 30, ISSUE 3, P367-369, June 2017

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Congenital Venous Lymphatic Malformation as an Unusual Source of Premenarchal Vaginal Bleeding

Published:February 12, 2016DOI:



      Premenarchal vaginal bleeding can present a diagnostic challenge and has not been previously reported in association with congenital venous lymphatic malformation.


      A 3-year-old girl presented with intermittent vaginal bleeding since birth. Evaluation showed premenarchal estradiol and gonadotropin hormones, a normal pelvic ultrasound and normal colonoscopy. Examination under anesthesia and vaginoscopy showed a congested appearance of the hymen and vaginal petechiae. Sudden development of a vulvar cyst led to a pelvic magnetic resonance imaging scan, which revealed a venous malformation of the pelvis and vulvar lymphatic cyst. Vaginal bleeding stopped for approximately 6 months after sclerotherapy with doxycycline and ethanol, however recurred and required repeat sclerotherapy.

      Summary and Conclusion

      Congenital venous lymphatic malformations can rarely be associated with premenarchal vaginal bleeding and should be considered when all more common etiologies have been ruled out. Diagnosis is made using magnetic resonance imaging, and treatment might include doxycycline and ethanol sclerotherapy.

      Key Words

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        • Fishman A.
        • Paldi E.
        Vaginal bleeding in premenarchal girls: a review.
        Obstet Gynecol Surv. 1991; 46: 457
        • Dobson M.J.
        • Hartley R.W.
        • Ashleigh R.
        • et al.
        MR angiography and MR imaging of symptomatic vascular malformations.
        Clin Radiol. 1997; 52: 595
        • Herman A.R.
        • Morello F.
        • Strickland J.L.
        Vulvar venous malformations in an 11-year-old girl: a case report.
        J Pediatr Adolesc Gynecol. 2004; 17: 179
        • Yun W.S.
        • Kim D.I.
        • Rho Y.N.
        • et al.
        Natural course of venous malformation after conservative treatment.
        Surg Today. 2012; 42: 950
        • Schumacher M.
        • Ernemann U.
        • Berlis A.
        • et al.
        Treatment of venous malformations – comparison to lymphatic malformations.
        Lymphology. 2008; 41: 139
        • Marrocco-Trischitta M.M.
        • Nicodemi E.M.
        • Nater C.
        • et al.
        Management of congenital venous malformations of the vulva.
        Obstet Gynecol. 2001; 98: 789
        • Lee B.B.
        • Do Y.S.
        • Byun H.S.
        • et al.
        Advanced management of venous malformation with ethanol sclerotherapy: mid term results.
        J Vasc Surg. 2003; 37: 533
        • Yun W.S.
        • Kim Y.W.
        • Lee K.B.
        • et al.
        Predictors of response to percutaneous ethanol sclerotherapy in patients with venous malformations.
        J Vasc Surg. 2009; 50: 581