Presentation
History of recurrent miscarriages.
Patient Data
There is variant uterine morphology, with two uterine horns present. There is wide separation between the left and right uterine cavities, which measures 44 mm at the fundus and is 22 mm in length. This extends as a thin septum through the cervix. The serosal contour of the uterus displays only a very slight dip at the fundus (<1cm).
Secretory endometrium with a thickness of 13mm in both horns. Normal myometrium.
Normal ovaries. Adjacent to the right ovary is a tubular fluid-filled structure that may represent a hydrosalpinx.
Case Discussion
This is a complete septate uterus.
The two uterine cavities are fairly widely splayed, and it is perhaps for this reason that the uterine configuration was previously named didelphys (on earlier scans, not included here).
Assessment of the serosal fundal contour is key here. There is contiguous myometrium between the two horns (hence not a didelphys), with only a slight dip in the fundal contour (hence not a bicornuate). The appearance is consistent with a septate uterus, albeit with a fairly thick septum. Extension into the cervix does
The distinction is important, particularly in a patient with prior miscarriages who is seeking fertility as a septate uterus has the highest association with pregnancy loss. It is also potentially surgically treatable, although given the thickness of the septum in this case it may not be readily amenable to resection.
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