Septate versus bicornuate uterus

Case contributed by Dr Bruno Di Muzio

Presentation:

26 years old woman with difficulty in conceiving.

Patient Data:

Age: 26
Gender: Female

Hysterosalpingography

Modality: X-ray

Serie of images in hysterosalpingography showing the endometrial cavity to be divided in two separated cornus. 

Case Discussion:

In this case we didn't have access to other modality of image to make the differentiation between septate and bicornuate uterus, which can be easily assessed with ultrasound. 

Congenital abnormalities of uterine shape are due to abnormal fusion of the müllerian ducts during early (6 - 12 weeks) gestation.

If the two müllerian ducts do not completely fuse, a bicornuate uterus is formed. All bicornuate uteri will demonstrate a cleft in the outer contour of the fundus. The amount of fusion of the müllerian ducts can vary from minimal union to nearly complete union. When the two ducts fuse but there is incomplete resorption of the intervening septum, a septate uterus results. The length of the septum can vary depending on the degree of resorption (complete vs partial septum), similar to the bicornuate uterine anomaly. Unlike the bicornuate uterine deformity, the septate and arcuate deformities have a normal outer uterine contour. Optimal visualization of the outer contour (such as an ultrasound study) is important in differentiating among these various anomalies.

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