Septate uterus

Case contributed by Dr Praveen Jha

Presentation

Prior recurrent abortions. Unable to conceive since 1 year.

Patient Data

Age: 34
Gender: Female
MRI

Diverging cornu is seen, with a thin septum running across uterine cavity all the way to cervical canal, probably reaching just above external os. Vagina and external os are single. In spite of diverging cornu with obtuse angle, external surface of uterus is convex or atleast can be termed 'flat' rather than convex or bifid.

I could not explain the extensive fatty marrow in bilateral proximal femori, but could be due to excessive hormonal intakes since last 3-5 years.

Case Discussion

Prior hysterosalpingography (not included) showed two diverging uterine cavities, with large intercornual distance and wide angle of divergence, which was interpreted as bicornuate bicollis uterus.

However, 'angle of divergence' and 'intercornual distance' are losing relevance for infertility specialists. They need to clearly understand the external surface of uterus if its bifid or concave, which is usually termed a 'bicornuate uterus' and requires metroplasty.

In this case, external fundal surface is convex or atleast can be termed 'flat' in some images, but definitely not bifid or concave. This MRI should be interpreted as a septate uterus, with a thin almost complete septum across uterine cavity, not reaching external os or vagina, with maintained fundal external surface. 

As we have to choose one of the two- I prefer to call it a 'septate uterus' and not a 'bicornuate uterus', which was agreed by infertility specialist, who treated by resection of uterine septum, with no enthusiasm for metroplasty in this case.

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Case information

rID: 35180
Case created: 25th Mar 2015
Last edited: 14th Sep 2017
System: Gynaecology
Inclusion in quiz mode: Included

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