Müllerian duct anomalies
Citation, DOI & article data
Müllerian duct anomalies (MDAs) are congenital abnormalities that occur when the Müllerian ducts (paramesonephric ducts) do not develop correctly. This may be as a result of complete agenesis, defective vertical or lateral fusion, or resorption failure.
MDAs are estimated to occur in 1-5% of all women. There is a higher rate of women with repeated miscarriages (3-15%) 2,5.
Despite these anomalies being common 1, the majority are asymptomatic. Obstruction of the Müllerian duct may occur, and patients present with an abdominal mass and dysmenorrhea. Delayed treatment may result in severe consequences and potentially infertility. Patients may also present with recurrent miscarriages and infertility 2,5.
The Müllerian duct anomaly classification system divides them according to clinical manifestations, prognosis, and treatment. Accurate diagnosis is essential since management varies according to the type of malformation.
- uterine agenesis: ~10%
- arcuate uterus: often considered as part of normal anatomical variation, ~7%
- unicornuate uterus: ~15% (range 5-25%)
- uterine duplication anomalies
- should be performed initially
- confirms any structural abnormalities of the genital tract
- sometimes cannot help to identify the type of MDA (especially on 2D imaging alone)
- 3D coronal transvaginal imaging has a high degree of diagnostic accuracy and ideally should be performed in the secretory phase of the menstrual cycle
- valuable noninvasive technique
- evaluation of the female pelvic anatomy
- accurate MDA classification
Treatment and prognosis
Many patients are asymptomatic and require no treatment. However, where obstruction occurs, surgical intervention is usually required and may result in permanent infertility - counseling is required.
- 1. Junqueira B, Allen L, Spitzer R, Lucco K, Babyn P, Doria A. Müllerian Duct Anomalies and Mimics in Children and Adolescents: Correlative Intraoperative Assessment with Clinical Imaging. Radiographics. 2009;29(4):1085-103. doi:10.1148/rg.294085737 - Pubmed
- 2. Troiano R & McCarthy S. Mullerian Duct Anomalies: Imaging and Clinical Issues. Radiology. 2004;233(1):19-34. doi:10.1148/radiol.2331020777 - Pubmed
- 3. Steinkeler J, Woodfield C, Lazarus E, Hillstrom M. Female Infertility: A Systematic Approach to Radiologic Imaging and Diagnosis. Radiographics. 2009;29(5):1353-70. doi:10.1148/rg.295095047 - Pubmed
- 4. Saleem S. MR Imaging Diagnosis of Uterovaginal Anomalies: Current State of the Art. Radiographics. 2003;23(5):e13. doi:10.1148/rg.e13 - Pubmed
- 5. Behr S, Courtier J, Qayyum A. Imaging of Müllerian Duct Anomalies. Radiographics. 2012;32(6):E233-50. doi:10.1148/rg.326125515 - Pubmed