Case 43

A 7-year-old girl was brought to the emergency department by the mother for evaluation of swelling ‘down there’. She reported to her mother that she fell in the park. Her mother was concerned that she was sexually molested. During examination, these findings were noted (Image 43a). Child was not seen for follow-up to demonstrate diminution in the size of labia and clitoral hood with resolution of hematoma.

Were the mother’s concerns reasonable given the images provided?

Would additional history and information from prior medical exams have been helpful?

What other findings are noted?

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The mother should be concerned about trauma from whatever cause. Image 43a shows a swelling of the right labia majorum and clitoral hood consistent with blunt trauma.

Further evaluation (Images 43b and 43c) demonstrates a haemangioma that appeared to have been traumatized with subsequent bleeding into the haemangioma. The mother reported that she has noted a slight difference in the size of the child’s labia from infancy. After the child complained of pain after a fall on the monkey bars, her mother saw a marked increase in the size and change in colour of the area.

The images show asymmetry with one side having a mild labial adhesion with no apparent hymenal injury. Hymenal findings are uncommon after blunt accidental trauma to the genitals, although they can occur in association with severe external findings and can simulate child abuse. ¹