Differential Diagnosis for Vaginal Swelling
- Single most likely diagnosis
- C. Greater vestibular glands: The description of a pink, 2 x 2-cm, fluctuant swelling at the right posterior vaginal introitus is most consistent with a Bartholin's cyst, which arises from the greater vestibular glands. These glands are located on each side of the vaginal introitus and can become obstructed, leading to cyst formation.
- Other Likely diagnoses
- A. Vulvar epithelium: A vulvar cyst or inclusion cyst could present similarly, although these are less common and might not have the same characteristic location or fluctuance.
- E. Sebaceous glands: A sebaceous cyst could also be considered, but these are generally less common in the vaginal introitus area and might not be as fluctuant.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- D. Mesonephric duct remnants: Although rare, a Gartner's duct cyst could be considered, especially if the swelling is more anterior or if there are concerns about urinary tract anomalies. These cysts arise from remnants of the mesonephric ducts and can be associated with other genitourinary anomalies.
- B. Paraurethral glands: A paraurethral cyst or abscess could present with similar symptoms but is less likely given the posterior location. However, missing a paraurethral abscess could lead to significant morbidity due to potential complications like urinary retention or fistula formation.
- Rare diagnoses
- Malignant tumors: Although extremely rare in this age group and location, malignant tumors such as adenocarcinoma of the Bartholin's gland or other vulvar cancers should be considered in the differential diagnosis to ensure that no potentially life-threatening condition is overlooked.
- Other rare cysts or tumors: Including but not limited to, dermatoid cysts, or other soft tissue tumors that could present as a fluctuant mass in the vaginal introitus area.