Herlyn-Werner-Wunderlich syndrome with endometrioma and hematosalpinx

Case contributed by Dr Salma Babikir Ahmed Erabi
Diagnosis almost certain


Severe left side pelvic pain.

Patient Data

Age: 20 years
Gender: Female

Large left ovarian well-defined unilocular cyst showing internal low-level echoes, with no vascularity compatible with Endometrioma.

The uterus is divided into two separate horns.

The left kidney is absent.

There is a large left side cystic mass replacing the left ovary with internal fine septations, it shows high T1WI signal that doesn't suppress on fat sat compatible with blood content. It shows shading sign on T2WI, compatible with Endometrioma.

The left fallopian tube is dilated with internal high T1WI content compatible with Hematosalpinx.

There is a complete duplication of uterine horns as well as duplication of the cervix, with no communication between them compatible with Uterine didelphys , the left uterine horn, cervix, and upper vagina are filled with internal high T1WI content compatible Hematometrocolpos.

Left Renal agenesis.  

Case Discussion

Uterine didelphys is associated with transverse vaginal septum and obstruction to one horn is possible, also associated with renal agenesis.

Shading sign is highly associated with endometrioma

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