Overlooked diseases of the vagina: a directed anatomic-pathologic approach for imaging assessment

The vagina can easily be overlooked at ultrasonography (US), computed tomography (CT), or magnetic resonance (MR) imaging performed for nongynecologic indications. Even when gynecologic disease is suspected, the vagina may be underevaluated at routine pelvic US due to probe positioning and at CT due to poor vaginal tissue characterization. Although MR imaging offers excellent tissue characterization, radiologists must focus on the vaginal area to recognize any incidental findings. A directed anatomic-pathologic approach to assessing the vagina at US, CT, and MR imaging is recommended so that pertinent findings are not missed. This approach requires a knowledge of the anatomy and embryologic development of the vagina, as well as an understanding of congenital, developmental, and postoperative vaginal disease entities. In addition, it is important to understand the strengths and limitations of each imaging modality with respect to vaginal assessment. By remembering to "look beyond" the uterus and cervix to the vagina, radiologists can improve their perception and interpretation of vaginal anatomy and disease.