Arcuate uterus

Case contributed by Dr Amir Mahmud

Presentation

Patient with primary infertility, who presented for an HSG as part of her evaluation.

Patient Data

Age: 35 years
Gender: Female
Fluoroscopy

There is a broad, smooth indentation of the uterine fundus (fundal endometrial canal), which measures 12 mm in its maximal depth from the level of the uterine horns.

No evidence of stricturing nor septation.

Contrast is not seen to fill the fallopian tubes, and there is no free spillage of contrast into the peritoneal cavity, even on delayed imaging.

Case Discussion

An arcuate uterus is a type of a Mullerian duct anomaly in which there is near reabsorption of the uterovaginal septum and where an indentation exists on the endometrium at the uterine fundus. It is the most common, yet mildest type (is least commonly associated with reproductive failure). 

Here, the indentation is readily visualized, and while typically the depth of this indentation is considered to be <1 cm, in this case, it measured 1.2 cm in its maximal dimension.

However, these appearances may overlap with those of a partial bicornuate uterus, which results from incomplete or partial fusion of the Müllerian ducts.

The US or MRI appearance of a smooth external fundal contour is used to distinguish an arcuate uterus from a bicornuate or partial bicornuate uterus, where the external contour will have a cleft.

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Case information

rID: 73155
Published: 28th Dec 2019
Last edited: 28th Dec 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Aga Khan University Hospital Nairobi

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