Abstract
Background
Premenarchal vaginal bleeding can present a diagnostic challenge and has not been
previously reported in association with congenital venous lymphatic malformation.
Case
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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Article info
Publication history
Published online: February 12, 2016
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
