Mullerian duct anomaly with renal agenesis and lying down adrenal sign
Presentation
Incidental findings of unicornuate uterus with accessory horn adhered to the pelvic wall during Cesarean section.
Patient Data
Abnormal uterine configuration with two uterine horns, smaller on the left. Mild hydrometra within both horns. Both ovaries are present and mildly enlarged, however, no mass is seen within. Overlying intraperitoneal and subcutaneous fat streakiness in keeping with recent surgery.
Single right kidney. No kidney is seen within the left renal fossa or pelvis. No crossed-fused ectopia.
The right adrenal gland is normal. the left adrenal gland is linear in configuration (lying down adrenal sign).
Features suggestive of Müllerian duct anomaly with left renal agenesis.
The yellow arrow points to the linear configuration of the left adrenal gland giving rise to the lying down adrenal sign. The blue arrow points to the normal Y-shaped configuration of the right adrenal gland.
Case Discussion
The lying down adrenal sign helps to confirm renal agenesis as the adrenal gland loses its normal Y-shaped configuration due to the congenital absence of the kidney.
Intraoperatively during Cesarean section, the uterus was seen to be unicornuate with an accessory horn adhered to the pelvic wall. On CT, it is difficult to ascertain whether the rudimentary horn is communicating or non-communicating. MRI would be a better modality to assess Müllerian duct anomalies.
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