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A) Didelphys uterus INCORRECT
A didelphys uterus occurs as a result of complete nonfusion of the Müllerian duct, resulting in duplicated uterine horns, duplicated cervices, and occasionally the proximal vagina, which is often associated with a transverse or longitudinal vaginal septum.1,2 Fusion anomalies (didelphys and bicornuate) can be differentiated from resorption anomalies (septate and arcuate) on ultrasonography (US) by a deep fundal cleft (>1 cm).1 3D US is highly accurate in identifying Müllerian duct anomalies (MDAs), it correlates well with magnetic resonance imaging (MRI), and it is more cost effective and accessible.3 For the didelphys uterus, 3D US obtained coronal to the uterine fundus often demonstrates widely divergent uterine horns separated by a deep serosal fundal cleft (>1 cm) and noncommunicating endometrial cavities with 2 cervices.1 Identifying a duplicated vaginal canal can help differentiate a didelphys uterus from a bicornuate bicollis uterus.1
B) Unicornuate uterus INCORRECT
A unicornuate uterus results from arrested development of one Müllerian duct and normal development of the other. There are 4 different subtypes: no rudimentary horn, rudimentary horn without endometrial cavity, rudimentary horn with communicating endometrial cavity, and rudimentary horn with noncommunicating uterine cavity.1 Renal anomalies, especially renal agenesis when present, are usually ipsilateral to the rudimentary horn.1 On US, unicornuate uterus appears as a lobular oblong (banana-shaped) structure away from the midline. The rudimentary horn is often difficult to identify and, when seen, the presence or absence of endometrium is an important finding.1
C) Partial septate uterus CORRECT
A septate uterus is a result of a resorption anomaly. The septum may be partial (subseptate) or complete secondary to failure of resorption of the uterovaginal septum. A complete septum extends to the external cervical os and occasionally to the vagina.1 US demonstrates interruption of the myometrium by a hypoechoic fibrous septum and/or a muscular septum which is isoechoic to the myometrium and arises midline from the fundus.1 3D US often clearly delineates the septum and improves visualization of the external fundal contour.2 The external fundal contour in septate uterus is convex (little or no serosal fundal cleft) and the apex is greater than 5 mm above the interostial line compared with a bicornuate or didelphys uterus, where the apex is less than 5 mm from the interostial line.1,2 Additionally, the intercornual distance is less than 4 cm.4 A septate uterus with duplicated cervix can appear similar to a bicornuate bicollis uterus and can be correctly diagnosed by evaluating the external fundal contour.1
D) Arcuate uterus INCORRECT
The arcuate uterus also represents a resorption anomaly as a sequela of near-complete resorption of the uterovaginal septum.1 On 3D US, the fundal indentation in an arcuate uterus is well delineated and appears broad based with an obtuse angle at the most central point, which can help differentiate it from a septate uterus that has an acute angle.2,3 Both an arcuate and a septate uterus have a normal external (serosal) fundal contour.2,3 With an arcuate uterus, the length of the vertical measurement from the tubal ostia line, which is drawn horizontally between the tubal ostia to the fundal midline component of the endometrial cavity, is 1 cm or less. With a septate uterus, this vertical distance is greater than 1 cm.
- CambriaBehr SC, Courtier JL, Qayyum A. Imaging of MMS PGothicüCambriallerian duct anomalies. RadioGraphics. 2012;32(6):e23.
- Bermejo C, Martinez Ten P, Diaz D, et al. Three-dimensional ultrasound in the diagnosis of MMS PGothicüCambriallerian duct anomaly and concordance with MRI. Ultrasound Obstet Gynecol.Cambria 2010;35(5):593–601.
- Deutch TD, Abuhamed AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of MMS PGothicüCambriallerian duct anomalies. J Ultrasound Med. 2008;27(3):413–423.
- CambriaChandler TM, Machan LS, Cooperberg PL, Harris AC, Chang SD. MMS PGothicüCambriallerian duct anomalies: from diagnosis to intervention.Cambria Br J Radiol. 2009;82(984):1034–1042.
Dr. Kanmaniraja is Assistant Professor and Chief, Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine–Jacksonville. He is Medical Director and Director of Menopause and Gynecologic Ultrasound Services at UF Women’s Health Specialists–Emerson. He also serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this quiz.
The authors wish to acknowledge Leeber S. Cohen, MD, Professor of Obstetrics and Gynecology in the Division of Diagnostic Ultrasound at Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Dr. Kanmaniraja is Assistant Professor and Chief, Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine–Jacksonville. He is Medical Director and Director of Menopause and Gynecologic Ultrasound Services at UF Women’s Health Specialists–Emerson. He also serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this quiz.
The authors wish to acknowledge Leeber S. Cohen, MD, Professor of Obstetrics and Gynecology in the Division of Diagnostic Ultrasound at Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Dr. Kanmaniraja is Assistant Professor and Chief, Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine–Jacksonville.
Dr. Kaunitz is University of Florida Research Foundation Professor and Associate Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine–Jacksonville. He is Medical Director and Director of Menopause and Gynecologic Ultrasound Services at UF Women’s Health Specialists–Emerson. He also serves on the OBG Management Board of Editors.
The authors report no financial relationships relevant to this quiz.
The authors wish to acknowledge Leeber S. Cohen, MD, Professor of Obstetrics and Gynecology in the Division of Diagnostic Ultrasound at Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
A) Didelphys uterus INCORRECT
A didelphys uterus occurs as a result of complete nonfusion of the Müllerian duct, resulting in duplicated uterine horns, duplicated cervices, and occasionally the proximal vagina, which is often associated with a transverse or longitudinal vaginal septum.1,2 Fusion anomalies (didelphys and bicornuate) can be differentiated from resorption anomalies (septate and arcuate) on ultrasonography (US) by a deep fundal cleft (>1 cm).1 3D US is highly accurate in identifying Müllerian duct anomalies (MDAs), it correlates well with magnetic resonance imaging (MRI), and it is more cost effective and accessible.3 For the didelphys uterus, 3D US obtained coronal to the uterine fundus often demonstrates widely divergent uterine horns separated by a deep serosal fundal cleft (>1 cm) and noncommunicating endometrial cavities with 2 cervices.1 Identifying a duplicated vaginal canal can help differentiate a didelphys uterus from a bicornuate bicollis uterus.1
B) Unicornuate uterus INCORRECT
A unicornuate uterus results from arrested development of one Müllerian duct and normal development of the other. There are 4 different subtypes: no rudimentary horn, rudimentary horn without endometrial cavity, rudimentary horn with communicating endometrial cavity, and rudimentary horn with noncommunicating uterine cavity.1 Renal anomalies, especially renal agenesis when present, are usually ipsilateral to the rudimentary horn.1 On US, unicornuate uterus appears as a lobular oblong (banana-shaped) structure away from the midline. The rudimentary horn is often difficult to identify and, when seen, the presence or absence of endometrium is an important finding.1
C) Partial septate uterus CORRECT
A septate uterus is a result of a resorption anomaly. The septum may be partial (subseptate) or complete secondary to failure of resorption of the uterovaginal septum. A complete septum extends to the external cervical os and occasionally to the vagina.1 US demonstrates interruption of the myometrium by a hypoechoic fibrous septum and/or a muscular septum which is isoechoic to the myometrium and arises midline from the fundus.1 3D US often clearly delineates the septum and improves visualization of the external fundal contour.2 The external fundal contour in septate uterus is convex (little or no serosal fundal cleft) and the apex is greater than 5 mm above the interostial line compared with a bicornuate or didelphys uterus, where the apex is less than 5 mm from the interostial line.1,2 Additionally, the intercornual distance is less than 4 cm.4 A septate uterus with duplicated cervix can appear similar to a bicornuate bicollis uterus and can be correctly diagnosed by evaluating the external fundal contour.1
D) Arcuate uterus INCORRECT
The arcuate uterus also represents a resorption anomaly as a sequela of near-complete resorption of the uterovaginal septum.1 On 3D US, the fundal indentation in an arcuate uterus is well delineated and appears broad based with an obtuse angle at the most central point, which can help differentiate it from a septate uterus that has an acute angle.2,3 Both an arcuate and a septate uterus have a normal external (serosal) fundal contour.2,3 With an arcuate uterus, the length of the vertical measurement from the tubal ostia line, which is drawn horizontally between the tubal ostia to the fundal midline component of the endometrial cavity, is 1 cm or less. With a septate uterus, this vertical distance is greater than 1 cm.
A) Didelphys uterus INCORRECT
A didelphys uterus occurs as a result of complete nonfusion of the Müllerian duct, resulting in duplicated uterine horns, duplicated cervices, and occasionally the proximal vagina, which is often associated with a transverse or longitudinal vaginal septum.1,2 Fusion anomalies (didelphys and bicornuate) can be differentiated from resorption anomalies (septate and arcuate) on ultrasonography (US) by a deep fundal cleft (>1 cm).1 3D US is highly accurate in identifying Müllerian duct anomalies (MDAs), it correlates well with magnetic resonance imaging (MRI), and it is more cost effective and accessible.3 For the didelphys uterus, 3D US obtained coronal to the uterine fundus often demonstrates widely divergent uterine horns separated by a deep serosal fundal cleft (>1 cm) and noncommunicating endometrial cavities with 2 cervices.1 Identifying a duplicated vaginal canal can help differentiate a didelphys uterus from a bicornuate bicollis uterus.1
B) Unicornuate uterus INCORRECT
A unicornuate uterus results from arrested development of one Müllerian duct and normal development of the other. There are 4 different subtypes: no rudimentary horn, rudimentary horn without endometrial cavity, rudimentary horn with communicating endometrial cavity, and rudimentary horn with noncommunicating uterine cavity.1 Renal anomalies, especially renal agenesis when present, are usually ipsilateral to the rudimentary horn.1 On US, unicornuate uterus appears as a lobular oblong (banana-shaped) structure away from the midline. The rudimentary horn is often difficult to identify and, when seen, the presence or absence of endometrium is an important finding.1
C) Partial septate uterus CORRECT
A septate uterus is a result of a resorption anomaly. The septum may be partial (subseptate) or complete secondary to failure of resorption of the uterovaginal septum. A complete septum extends to the external cervical os and occasionally to the vagina.1 US demonstrates interruption of the myometrium by a hypoechoic fibrous septum and/or a muscular septum which is isoechoic to the myometrium and arises midline from the fundus.1 3D US often clearly delineates the septum and improves visualization of the external fundal contour.2 The external fundal contour in septate uterus is convex (little or no serosal fundal cleft) and the apex is greater than 5 mm above the interostial line compared with a bicornuate or didelphys uterus, where the apex is less than 5 mm from the interostial line.1,2 Additionally, the intercornual distance is less than 4 cm.4 A septate uterus with duplicated cervix can appear similar to a bicornuate bicollis uterus and can be correctly diagnosed by evaluating the external fundal contour.1
D) Arcuate uterus INCORRECT
The arcuate uterus also represents a resorption anomaly as a sequela of near-complete resorption of the uterovaginal septum.1 On 3D US, the fundal indentation in an arcuate uterus is well delineated and appears broad based with an obtuse angle at the most central point, which can help differentiate it from a septate uterus that has an acute angle.2,3 Both an arcuate and a septate uterus have a normal external (serosal) fundal contour.2,3 With an arcuate uterus, the length of the vertical measurement from the tubal ostia line, which is drawn horizontally between the tubal ostia to the fundal midline component of the endometrial cavity, is 1 cm or less. With a septate uterus, this vertical distance is greater than 1 cm.
- CambriaBehr SC, Courtier JL, Qayyum A. Imaging of MMS PGothicüCambriallerian duct anomalies. RadioGraphics. 2012;32(6):e23.
- Bermejo C, Martinez Ten P, Diaz D, et al. Three-dimensional ultrasound in the diagnosis of MMS PGothicüCambriallerian duct anomaly and concordance with MRI. Ultrasound Obstet Gynecol.Cambria 2010;35(5):593–601.
- Deutch TD, Abuhamed AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of MMS PGothicüCambriallerian duct anomalies. J Ultrasound Med. 2008;27(3):413–423.
- CambriaChandler TM, Machan LS, Cooperberg PL, Harris AC, Chang SD. MMS PGothicüCambriallerian duct anomalies: from diagnosis to intervention.Cambria Br J Radiol. 2009;82(984):1034–1042.
- CambriaBehr SC, Courtier JL, Qayyum A. Imaging of MMS PGothicüCambriallerian duct anomalies. RadioGraphics. 2012;32(6):e23.
- Bermejo C, Martinez Ten P, Diaz D, et al. Three-dimensional ultrasound in the diagnosis of MMS PGothicüCambriallerian duct anomaly and concordance with MRI. Ultrasound Obstet Gynecol.Cambria 2010;35(5):593–601.
- Deutch TD, Abuhamed AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of MMS PGothicüCambriallerian duct anomalies. J Ultrasound Med. 2008;27(3):413–423.
- CambriaChandler TM, Machan LS, Cooperberg PL, Harris AC, Chang SD. MMS PGothicüCambriallerian duct anomalies: from diagnosis to intervention.Cambria Br J Radiol. 2009;82(984):1034–1042.
A 29-year-old woman presents to her ObGyn’s office with a history of multiple miscarriages. Transverse pelvic 2D ultrasonography of the uterus (A) and coronal 3D imaging (B) are performed.
