A 44year reproductive age woman came to outpatient Department of Gynaecology, Anil Neerukonda Hospital with complaints of excessive bleeding (Menorrhagia) and abdominal pain. Evaluation and Treatment of Cystic lesions which are often encountered and rarely diagnosed in Urogynecological practice. This is a rare case and will be confused with other cysts like Retrorectal cyst12 ,Tailgut duplication cyst or Cyst arising from anterior wall of rectum and also Gynaecological cysts like Gartner’s cyst1,Paravaginal Dermoid cyst10 and Retention cysts like Epidermoid Cysts and Squamous inclusion cyst. Cystic lesion of vagina are benign. Mostly they may haveembryological origin, Ectopic tissue or Neurological abnormality .Awareness of these conditions is very important for diagnosis and treatment. While these lesions may be detected on ultrasound (US), Computed tomography (CT), or MRI. MRI has superior contrast resolution and allows for distinction between the various types of cysts, with location being the most important discriminating factor(Anuj Gupta, D.O., James E. Kovacs, D.O.). In females, the diverticula commonly extend from the posterolateral wall of the mid-portion of the short female urethra. During voiding cystourethrography (VCUG), they are best portrayed on post void images. On transrectal or transperineal US, a cystic mass with complex fluid in proximity to the urethra will be seen anterior to the vaginal wall. Trans perineal US may be useful as an initial diagnostic examination tool; however, transrectal US will have greater specificity for small diverticula. Advantages of US over CT include better localization, lack of radiation, and capacity to differentiate solid from cystic masses. CT will demonstrate a periurethral lesion with low attenuation. On MRI, urethral diverticula will contain T1 hypo intense and T2 hyperintense fluid signal intensity. Postcontrast imaging with Gadolinium can be used to evaluate for infection or inflammation. To differentiate and diagnose the origin of mass above investigations are necessary as mentioned in above articles .The main aim of presenting this case is of its size which occupying below from vulvar outlet to 1inch above the vault and laterally complete left lateral wall clinically. On clinical examination and examination under anaesthesia the upper border of the mass could not be felt causing clinical dilemma. The radiological imaging by Ultrasonography could not throw much light regarding type location and origin of mass. MRI was done to know the plane of mass. As patient had abnormal uterine bleeding and mass is very big up to vault planned for surgery by abdominal pelvic approach. Total abdominal hysterectomy was done, ovaries left behind as they are healthy. Cyst excised through vaginal route and sent for histopathology.
