Bicornuate uterus with renal agenesis

Case contributed by Hoe Han Guan
Diagnosis almost certain

Presentation

Recurrent miscarriage.

Patient Data

Age: 30 years

The external uterine contour is concave or heart-shaped, and the uterine horns are widely divergent.. Significant fundal cleft at the uterus (>1cm) indicates no fusion of the upper-mid uterine horns with possible fusion of the mid-lower uterine horns. The intercornual distance is widened.

A rim-enhancing cyst seen at the right ovary which can represent corpus luteal cyst. Left ovary is normal.
Solitary left kidney which is slightly enlarged in bipolar length. No right kidney in keeping with right renal agenesis.

Annotated image

Annotated images for the bicornuate uterus and absence of right kidney (better seen in coronal view).

Case Discussion

A bicornuate uterus is a type of uterine duplication anomaly. It can be classified as a class IV Mullerian duct anomaly.  MRI is better imaging modality for depicting the degree of uterine fusion in order to differentiate between didelphys and bicornuate uterus.

The diagnosis of a didelphys should not be made based on the presence of two uterine, cervical, and vaginal canals, but upon the level of uterine fusion: if there is no fusion of any segment of the uterus, then a didelphys is present and if the lower/mid uterine segments are fused, then it is a bicornuate.

​Per speculum examination, this patient has only one external cervical os which suggests to be bicornuate unicollis (Class IV b - partial fusion).

​Renal anomalies are frequently associated, most commonly renal agenesis as seen in this case.

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