To analyze the ultrasound features of congenital vaginal atresia and to discuss the practical value of multipath ultrasonography in the diagnosis and differential diagnosis of this disease.

The ultrasound records of 22 patients with congenital vaginal atresia confirmed by surgery at Shenzhen Luohu District People's Hospital from March 2021 to May 2022 were retrospectively analyzed. All the patients had images obtained through transabdominal ultrasound, transperineal ultrasound, transrectal ultrasound, and transrectal biplanar high-frequency ultrasound before surgery. The features of different types of vaginal atresia were summarized and compared with the surgical outcomes.

The 22 patients with congenital vaginal atresia underwent transvaginal laparoscopic vaginoplasty or transperineal vaginoplasty. Among them, 13 cases were confirmed with type I vaginal atresia by surgery, 12 of which obtained a correct diagnosis by preoperative ultrasound, with a consistency rate of 92.3%. The other 9 cases were confirmed with type II vaginal atresia, and all of them obtained a correct diagnosis by ultrasound before surgery, with a consistency rate of 100%. Patients with type I vaginal atresia showed hematocele in the middle and upper vagina on transabdominal, transperineal, and transrectal ultrasound. No normal vaginal anatomy was visualized inferior to the hematocele or between the posterior urethovesical wall and the anterior rectal wall on transrectal biplanar high-frequency ultrasound. And merely an isoechonic connective tissue gap was seen, which was the lower part of the atresic vagina. The length of atresia was＜3 cm in 4 cases and ≥3 cm in 9 cases. As for patients with type II vaginal atresia, abnormal cervix development could be observed by transabdominal, transperineal, and transrectal ultrasound, and no hematocele was found in the vagina area between the posterior urethovesical wall and the anterior rectal wall. An isoechonic connective tissue gap could also be visualized by transrectal biplanar high-frequency ultrasound, without normal vagina anatomy between the posterior urethovesical wall and the anterior rectal wall. The gap width ranged from 1.2-7.8 (mean, 2.81 ± 1.01) mm at the level of the internal urethral orifice. Intraoperative diagnosis showed that the incidence of endometriosis among those 22 patients was 59.1% (13 / 22), of which peritoneal endometriosis accounted for 92.3% (12 / 13).

Multipath ultrasonography proves to be accurate in diagnosis and classification of congenital vaginal atresia and can provide reliable imaging evidence when it comes to customizing surgical treatments.