Rudimentary horn pregnancy with rupture

Case contributed by Alexandra Stanislavsky

Presentation

20-week pregnancy. Abdominal and shoulder tip pain. Hypotensive and tachycardiac.

Patient Data

Age: 30 years
Gender: Female
ultrasound

There is free fluid in all four quadrants of the abdomen. Fetus with no cardiac activity, in keeping with fetal death in utero.

The cause of abdominal free fluid and fetal death in utero was not identified on the initial ultrasound. However the patient was haemodynamically unstable and underwent an emergency laparotomy, during which an intact non-gravid uterus was identified, adjacent to a ruptured, gravid rudimentary horn. This was left in situ following delivery of the nonviable fetus.

ultrasound

The uterus is anteverted and normal in size. Unicornuate morphology is demonstrated.

Normal endometrium with 6.8mm thickness. No intracavity abnormality is seen.

A non-communicating left rudimentary uterine horn is present measuring 63x 59 x 65mm. There is no cervix seen or visible communication to the right unicornuate horn. Heterogeneous material is present within the cavity measuring 53x45x65mm (81m). No internal vascularity is seen.

Normal ovaries. No adnexal masses.

A small amount of free fluid is present in the Pouch of Douglas.

Both kidneys are present and normal in location and appearance.

Case Discussion

This was an unrecognised cornual ectopic pregnancy in a non communicating rudimentary horn of a unicornuate uterus. Patient presented acutely with rupture and FDIU at 20 weeks gestation.

The diagnsosis was made definitively at surgery. Placenta was known to be left in situ, for methotrexate therapy and bHCG tracking. 

Subsequent ultrasound demonstrates the right unicornuate uterus communicating with a single cervix. and the non-communicating left rudimentary horn containing hemorrhage and retained products of conception. 

There were no associated renal tract anomaly, however this should be sought routinely with any Mullerian duct anomaly due to the frequent association.

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