MyPACS.net: Radiology Teaching Files > Case 855311

never visited CLOACAL MALFORMATION
Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
Patient: 3 day old
History: Newborn with single perineal opening.
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Fig. 22: With Reflux
Diagnosis: CLOACAL MALFORMATION
Discussion:

Occurs only in girls. the rectum and the genital tract converge and join at different levels in the perineum and empty through a single perineal opening as a common outflow channel ( Cloaca in Latin means a sewer). Occurs in approximately 1 in 40 000 females.
Embryologically occurs due to persistence of the cloacal membrane, which interferes with normal closure of the anterior abdominal wall.The female external genitalia are normal. The anus is absent as the rectum joins the often septaed vagina. Evaluation with contrast after cannulation of the single opening is best done in the lateral projection. Ultrasound is useful to screen for associated renal and spinal anomalies.

Diego Jaramillo et alin the journal of Radiology described the malformations based on the cloacal configuration (urethral, vaginal), type of urinary-cloacal communication (urethral, vesical), and level of rectal communication (vaginal, cloacal, vesical, other).
Associated abnormalities include lower urinary tract abnormalities such as frequent (reflux, ureteral ectopia, bladder diverticula, bladder duplication, urachal remnants, urethral duplication), genital abnormalities (uterine duplication, vaginal duplication, uterine atresia, vaginal atresia), skeletal anomalies like involving the bony pelvis (partial sacral agenesis, pubic diastasis), and renal abnormalities (agenesis, obstruction, horseshoe kidney).
Imaging is performed with contrast material enabling definition of the cloaca and the distal limb of the colostomy with fluoroscopy and if needed genitograms, all in various projections , especially the lateral being crucial for diagnosis. Voiding cystourethrography is also important for detecting vesicoureteric reflux. Sonography allows evaluation for anomalies of the vagia and uterus and is valuable for imaging the kidneys. Ultrasound of the spine and MR imaging revealed that spinal cord abnormalities, which cannot be predicted based on the appearance of the lumbosacral spine are seen more commonly than previously thought.

References:

The Genital tract , Bloom,D. In Caffey’s pediatric diagnostic Imaging. Ninth edition. Edited by J Kuhn, T Slovis, J Haller. Mosbyan affiliate of Elsevier Sciences,Philadelphia. 2003.
Blickman, Hans. Pediatric Radiology: The Requisites. Mosby, 1998.
The Cloacal malformation: Radiologic findings and imaging recommendations.
Jaramillo D, Lebowitz RL, Hendren WH. Radiology. 1990 Nov;177(2):441-8.



Contributed by:
Philip J. Silberberg, M.D., Department of Radiology, Children's Hospital, Omaha, NE

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Additional Details:

Case Number: 855311Last Updated: 07-30-2006
Anatomy: Genitourinary (GU)   Pathology: Congenital
Modality: GU, USExam Date: 01-01-2000Access Level: Readable by all users
Keywords: cloacal malformation

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