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Case Reports
. 2022 Mar 2;17(5):1435-1439.
doi: 10.1016/j.radcr.2022.02.017. eCollection 2022 May.

The Herlyn-Werner-Wunderlich (HWW) syndrome - A case report with radiological review

Abdul Malik Hayat  1 , Khalid Rehman Yousaf  2 , Saman Chaudhary  2 , Sohaib Amjad  2
Affiliations
Case Reports

The Herlyn-Werner-Wunderlich (HWW) syndrome - A case report with radiological review

Abdul Malik Hayat et al. Radiol Case Rep. .

Abstract

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of female urogenital tract involving combined mullerian duct anomalies and mesonephric duct malformation characterized by uterus didelphys, obstructed hemi-vagina and ipsilateral renal agenesis which is also known as OHVIRA syndrome. It can be classified based on a completely or incompletely obstructed hemivagina. It presents soon after menarche or shows delayed presentation depending on the type. The most common presentation is lower abdominal pain, dysmenorrhea, and abdominal mass in the lower abdomen secondary to hematometra or hematocolpos. We present a 15-year-old unmarried patient with an unusual case of OHVIRA syndrome suffering from dysmenorrhea and painful mass in suprapubic region. We described the role of imaging modalities in diagnosis of the Herlyn-Werner Wunderlich syndrome with a review of literature. On USG and MRI, she had right renal agenesis with compensatory hypertrophy of the left kidney, didelphic uterus with an obstructed hemi-vagina on right side which led to marked distention of ipsilateral cervix and proximal vagina in the form of hematometrocolpos. OHVIRA syndrome can present early or late, depending on the type. In patients with uterine and vaginal abnormalities, a work-up for associated renal anomalies should be performed. The choice imaging modalities for the diagnosis of OHVIRA syndrome are ultrasound and MRI. Knowing the imaging findings of this rare condition is crucial for early diagnosis in order to prevent complications which may lead to endometriosis and infertility.

Keywords: Didelphys; Dysmenorrhea; Hematometrocolpos; Infertility; Mullerian ducts; Renal agenesis.

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Figures

Fig 1
Fig. 1
Ultrasound of the abdomen revealed absence of the right kidney.
Fig 2
Fig. 2
USG of pelvis demonstrates cystic dilatation of cervix having internal internal echoes.
Fig 3
Fig. 3
MRI Pelvis demonstrates, (A) uterus didelphys, (B) hematometrocolpos and 2 endometrial cavities.
Fig 4
Fig. 4
Axial MRI pelvis demonstrates hematocolpos with compressed leftt hemivagina.
Fig 5
Fig. 5
Post operative USG demonstrates no collection.
See this image and copyright information in PMC

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