Computed tomography features of emphysematous vaginitis: anatomic distribution and pattern recognition

Introduction: Emphysematous vaginitis (EV) is a rare benign condition characterized by subepithelial gas-filled cysts. This study aims to describe the clinical and CT imaging features of EV and assess factors associated with persistence on imaging. Materials and methods: We conducted a single-center retrospective study of consecutive patients who underwent CT imaging in which the clinical dictation from the radiology report suggested emphysematous vaginitis. Imaging was reviewed by a single abdominal radiologist with 3 years of post-fellowship experience. CTs were evaluated for gas within the vaginal wall, urethra, cervix, or other adjacent structures, as well as for gas-filled cysts, and findings were graded on a Likert scale. Additionally, labial involvement, cervical involvement, volume, rectal inflammation, anal inflammation, and cystitis were all evaluated. Results: The cohort included 13 female patients, aged between 23 and 84 years, with a mean age of 47.1 ± 19.5 years. Upon admission, 53.8% (7/13) of the patients were tested for Trichomonas, with 57.1% (4/7) testing positive. Vaginal canal involvement was most commonly entire (84.6%), with cervical extension in 69.2% of patients. Labial involvement was rare (7.7%), and no rectal or anal inflammation was observed. Cystitis was present in 30.8% of cases, including 7.7% with extension to the urethra. Conclusion: Recognition of the characteristic CT appearance of emphysematous vaginitis, with circumferential vaginal wall mottled gas and common cervical but infrequent labial involvement, can help radiologists distinguish this benign entity from necrotizing infections.