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Arcuate uterus

Dr Abhilash Sandhyala and Dr Natalie Yang et al.

An arcuate uterus is one of the Müllerian duct anomalies and the anomaly that is most commonly not associated with reproductive failure. It is sometimes classified as a normal variant.

Pathology

An arcuate uterus is characterized by a mild indentation of the endometrium at the uterine fundus. It occurs as the result of near complete resorption of the uterovaginal septum.

It can be distinguished from a bicornuate uterus on the basis of its complete fundal unification.

Radiographic features

General features include

normal fundal contour
no division of uterine horns
smooth indentation of fundal endometrial canal : the depth of indentation is usually considered to be < 1 cm.
increased transverse diameter of uterine cavity

Hysterosalpingogram

Opacification of the endometrial cavity demonstrates a single uterine canal with a broad saddle-shaped indentation of the uterine fundus.

Pelvic ultrasound

A normal external uterine contour is noted, with a broad smooth indentation on the fundal segment of the endometrium. No division of the uterine horns.

MRI

A normal external uterine contour is maintained. The myometrial fundal indentation is smooth and broad, and the signal intensity of this region is iso-intense to normal myometrium.