Arcuate uterus

Last revised by Dr Mostafa El-Feky on 24 May 2022

An arcuate uterus is a mildly variant shape of the uterus. It is technically one of the Müllerian duct anomalies, but is often classified as a normal variant. It is the uterine anomaly that is least commonly associated with reproductive failure. Arcuate uterus can be characterized with ultrasound or MRI.

An arcuate uterus is characterized by a mild indentation of the endometrium at the uterine fundus. It occurs due to a failure of complete resorption of the uterovaginal septum, and is the most common Mullerian duct anomaly, affecting 3.9% of the general population 7.

General features include:

On hysterosalpingograms there is opacification of the endometrial cavity demonstrates a single uterine canal with a broad saddle-shaped indentation of the uterine fundus.

A normal external uterine contour is noted, with a broad smooth indentation on the fundal segment of the endometrium. There should not be division of the uterine horns.

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

  • septate uterus
    • arcuate uterus and septate uterus exist on a spectrum from most to least resorption of the uterovaginal septum, respectively
  • bicornuate uterus
    • arcuate uterus can be distinguished from a bicornuate uterus on the basis of its complete fundal unification (i.e. an arcuate uterus has a normal or slightly indented external fundal contour, whereas a bicornuate uterus has a more marked fundal indentation, ≤5 mm above the level of the uterine horns)
  • fundal fibroid: on hysterosalpingography can exert smooth indentation of fundal endometrium giving similar appearance to arcuate uterus 8

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Cases and figures

  • Figure 1
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  • Case 1
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  • Case 2: arcuate uterus with intrauterine adhesions
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  • Case 3
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  • Case 4: with concurrent adenomyosis
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  • Case 5: hysterosalpingography
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  • Case 6
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  • Case 7
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