Vaginal cuff

The vaginal cuff (also known as the vaginal remnant) is the remnant tissue after a hysterectomy. The cuff may be evaluated for tumor recurrence (often with ultrasound) if the uterus was removed for cervical or endometrial carcinoma.

Radiographic findings

The appearance of the cuff depends on what type of hysterectomy was performed.

Ultrasound

The cuff will normally appear thin and hypoechoic with a total abdominal hysterectomy. The vaginal cuff in a supracervical hysterectomy will appear thicker and bulkier; sometimes this is termed the "cervical remnant" rather than the vaginal cuff.

Normal size

• total abdominal hysterectomy ¹
  • transabdominal ultrasound
    • anteroposterior: 1.5 +/- 0.5 cm
  • transvaginal ultrasound
    • anteroposterior: 1.8 +/- 0.6 cm
    • length: 2.1 +/- 0.7 cm
    • length with compression: 1.4 +/- 0.7 cm
• total vaginal hysterectomy ¹
  • transabdominal ultrasound
    • anteroposterior: 1.6 +/- 0.6 cm
  • transvaginal ultrasound
    • anteroposterior: 1.7 +/- 0.5 cm
    • length: 1.9 +/- 0.6 cm
    • length with compression: 1.2 +/- 0.8 cm
• supracervical hysterectomy ¹
  • transabdominal ultrasound
    • anteroposterior: 2.8 +/- 0.9 cm
  • transvaginal ultrasound
    • anteroposterior: 3.3 +/- 1.1 cm
    • length: 3.0 +/- 1.3 cm
    • length with compression: 1.4 +/- 0.3 cm

If the cuff or remnant is large, increasing in size, or becoming asymmetric, then this is suspicious for recurrence.

It is normal for a cuff or remnant to have a small amount of flow on color Doppler.

MRI

• a normal vaginal cuff may have a slightly nodular appearance on T1WI, but should be hypointense on T2WI ³

Practical points

• before calling recurrence in a large or bulky vaginal cuff, make sure that the surgery was not a supracervical hysterectomy