Septate uterus

Case contributed by Dr Mostafa El-Feky

Presentation

Secondary infertility.

Patient Data

Age: 35 years
Gender: Female
Ultrasound

The uterus is average in size with a uterine septum dividing the upper part of endometrial cavity into two separate cavities (septate uterus).

  • uterine septum length is 1.9 cm (>1.5 cm)
  • uterine septum girth is 1.5 cm
  • fundal indentation angle is ~73° (<90°)
  • intercornual distance <4 cm (3.2 cm)
  • convex uterine fundus with 1 cm myometrial thickness beyond the uterine septum base

Ultrasound shows left intra-ovarian simple cyst averaging 2.5 x 1.8 cm, with thin wall and clear fluid content. Mild right hydrosalpinx reaching 6 mm is also noted.

Case Discussion

The patient has two children in their teenage with a past history of recurrent abortion and in her current second marriage complaining of secondary infertility.

Supportive criteria for the diagnosis of septate uterus are:

  • depth from the interstitial line to the apex of the indentation >1.5 cm (septum length)
  • angle of the indentation <90 degrees
  • intercornual distance is not more than 4 cm
  • Convex uterine fundus 

Incidentally noted mild right hydrosalpinx, identified by the “cogwheel” appearance of the mucosal folds in cross-section.

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