Case Report

Transvaginal Ultrasonographic
Depiction of a Gartner Duct Cyst
David M. Sherer, MD, Ovadia Abulafia, MD

artner duct cysts, the most common benign cystic lesion of the vagina, represent embryologic remnants of the caudal end of the mesonephric (wolffian) duct.1 These cysts are usually small and asymptomatic and have been
reported to occur in as many as 1% of all women.1,2
Because the ureteral bud also develops from the wolffian duct, it is not surprising that
Gartner duct cysts have been associated with ureteral and renal abnormalities, including congenital ipsilateral renal dysgenesis or agenesis, crossed fused renal ectopia, and
ectopic ureters.1,37 In addition, associated anomalies of the female genital tract,
including structural uterine anomalies (ipsilateral mllerian duct obstruction, bicornuate uteri, and uterus didelphys) and diverticulosis of the fallopian tubes, have been
described.6,8,9
Transabdominal and transrectal ultrasonographic depiction of Gartner duct cysts
have been reported previously.2,5,7,10 Here we report the transvaginal ultrasonographic
findings of this condition.

Case Report

Received July 3, 2001, from the Division of

Maternal-Fetal Medicine, Department of Obstetrics
and Gynecology, St Lukes-Roosevelt Hospital
Center, Columbia University College of Physicians
and Surgeons, New York, New York; and Division
of Gynecologic Oncology, State University of New
York Health and Science Center at Brooklyn,
Brooklyn, New York. Revision requested July 18,
2001. Revised manuscript accepted for publication
August 2, 2001.
Address correspondence and reprint requests to
David M. Sherer, MD, Division of Maternal-Fetal
Medicine, Department of Obstetrics and
Gynecology, St Lukes-Roosevelt Hospital Center,
Columbia University College of Physicians and
Surgeons, 1000 10th Ave, Suite 11A, New York, NY
10019.

A 35-year-old gravida 5, para 2 patient had an anatomic

survey at 22 weeks gestation. Her obstetric history was
unremarkable, including 2 previous vaginal deliveries. At
4 years of age she had undergone surgical repair of
bilateral vesicoureteric reflux. The survey showed an
appropriate-for-gestational-age fetus with normalappearing midtrimester anatomic characteristics. The
uterine cervix measured 4 cm in length and was closed.
Distal to the external os of the uterine cervix, an ill-defined
cystic structure measuring 2 cm in diameter was depicted
(Fig. 1). Initially, this finding was considered consistent
with a nabothian cyst. Because of the lack of definitive cervical tissue around the cyst, transvaginal ultrasonography
was performed to further define this structure (Figs. 2 and
3). Sagittal transvaginal scanning (Fig. 2) depicted a well-

2001 by the American Institute of Ultrasound in Medicine J Ultrasound Med 20:12531255, 2001 0278-4297/01/$3.50

Transvaginal Ultrasonographic Depiction of a Gartner Duct Cyst

graphically and appeared normal. The pregnancy continued uneventfully, and the patient was
delivered of a healthy infant at term. At her 6week postpartum examination, the presence of
the Gartner duct cyst was again confirmed, and
expectant (nonsurgical) follow-up was planned.

Discussion

Figure 1. Sagittal transabdominal ultrasonographic view of the pelvis.

Note the cystic structure (calipers). bl indicates bladder; cx, cervix; and
VAG, vagina.

defined cystic mass on the anterolateral aspect of

the upper vaginal vault adjacent to, yet clearly
separate from, cervical tissue.
Transverse transvaginal scanning confirmed
these findings and depicted the cyst lateral to the
uterine cervix (Fig. 3). At this stage, the presence
of a Gartner duct cyst was considered. Physical
examination with a vaginal speculum confirmed
the presence of a cystic structure on the anterolateral aspect of the upper vaginal vault measuring
2 cm in size, consistent with a Gartner duct cyst.
Both maternal kidneys were depicted ultrasono-

Figure 2. Sagittal transvaginal ultrasonographic view of the pelvis. Note

the cystic structure (arrows), which proved on speculum examination to
be a Gartner duct cyst (c), and the clear anechoic line depicting the uterine cervix as separate from the cystic lesion (arrows). bl indicates bladder;
and cx, cevix.

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The differential diagnosis of cystic structures

located in the upper vagina and uterine cervix
includes nabothian cysts, Gartner duct cysts, and,
rarely, specific obstructed mllerian duct anomalies (usually uterus didelphys with obstructed
hemivagina).1113 The latter are not true cystic
lesions and usually contain echogenic contents
(obstructed menstrual debris), and patients with
these lesions commonly have cyclic symptoms
(primary dysmenorrhea). In contrast, patients
with nabothian cysts or Gartner duct cysts are
usually asymptomatic.11
Ultrasonographic depiction of cystic structures
within the uterine cervix are not uncommon, and
these usually are considered to represent nabothian (retention) cysts, reported to range between
6 and 20 mm in diameter and located eccentric to
the cervical canal.12,13 Gartner duct cysts also may
be depicted in close vicinity to the uterine cervix
and also should appear eccentric to the cervical
canal. Precise and accurate imaging distinction
between these 2 separate clinical entities may be

Figure 3. Transverse transvaginal ultrasonographic view of the pelvis.

Note the cystic structure (c) located lateral to the uterine cervix (cx).

J Ultrasound Med 20:12531255, 2001

Sherer and Abulafia

challenging with the transabdominal ultrasonographic approach, especially with regard to

small, isolated cysts. With transvaginal ultrasonography, the transducer is placed in immediate proximity to the cyst and cervix, enabling
accurate diagnosis and clearly differentiating
between Gartner duct and nabothian cysts, as
depicted in our case (Fig. 2). Similarly, transrectal
ultrasonography was applied in the assessment
of vaginal disease and diagnosis of 2 cases of
Gartner duct cysts.10 Nevertheless, transvaginal
ultrasonography appears a more direct imaging
modality for vaginal and cervical lesions.
The clinical importance in correct diagnosis
between patients with Gartner duct cysts and
those with cervical inclusion cysts is the previously mentioned association of the former with
ureteral, renal, and structural female genital tract
anomalies, some of which may require surgical
treatment.1,310
Our case shows the enhanced ultrasonographic imaging clarity of a Gartner duct cyst when
using the transvaginal compared with the transabdominal approach.

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