Adolescents With Labial Enlargement Misdiagnosed as Labial Masses on Imaging

Abstract

Background: Literature describing radiologic imaging of the adolescent labia is lacking and may lead to misdiagnoses and unnecessary medical care. Cases: Two adolescent patients presented with sudden-onset unilateral labia minora enlargement and underwent multiple imaging modalities which identified a discrete mass. One patient was diagnosed with aphthous ulcers after a prolonged emergency department stay, and the other underwent an exam under anesthesia for mass removal and was found to have an elongated labia minora rolled into itself. Conclusion: Labia minora enlargement in adolescents can be significant and may be mistaken for a discrete mass on radiologic imaging given a lack of literature on expected findings. Clinical correlation and understanding of age-appropriate etiologies of noninfectious labial swelling is crucial to avoid unnecessary medical therapies and procedures.

Keywords: aphthous ulceration; asymmetric labia; labia minora enlargement.

Figure 1

Patient 1 initial examination, imaging (ultrasound and MRI), and intraoperative findings. (a) Outpatient examination revealing an enlarged right labium minus “mass.” (b) Transverse high-resolution ultrasound with color Doppler confirms a hypoechoic solid lesion. (c) Axial T2-weighted MRI demonstrates a hyperintense lesion (arrow). (d) Postcontrast axial T1-weighted images with fat saturation show enhancing labial mass (arrows). (e) Intraoperative findings of an elongated right labium minus.

Figure 2

Patient 2 examination and imaging (ultrasound and MRI) findings. (a) Imaging findings on ED presentation. (b) Sagittal high-resolution ultrasound demonstrating a solid right labium mass with hyperemia on color Doppler imaging. (c) Coronal T2-weighted MRI demonstrating a hyperintense right labium mass (arrow). (d) Postcontrast coronal T1-weighted image with fat saturation shows intense heterogeneous enhancement of the mass (arrow).