Unicornuate uterus with renal anomaly

Case contributed by Dr Michael P Hartung


Abdominal pain.

Patient Data

Age: 30 years
Gender: Female



Normal left kidney. Dysplastic, malrotated, and pelvic location of right kidney. Unicornuate configuration of the uterus toward the left. Normal left ovary. Right ovary is abnormally positioned anterior to the right iliopsoas muscle at the level of the pelvic kidney (laterally). 

Fertility workup - HSG

DSA (angiography)

Catheter is present within the off-midline, fusiform uterine cavity projecting into the leftward pelvis. Contrast opacification of a single left fallopian tube with free intraperitoneal spillage of contrast.

HSG insufficient to evaluate for noncommunicated right rudimentary horn. MRI recommended. 

Fertility workup.


Leftward oriented unicornuate configuration of the uterus. No rudimentary horn. Normal left ovary. Right ovary is abnormally positioned anterior to the right iliopsoas muscle (lateral to the right kidney). Dysplastic, malrotated right pelvic kidney.

Case Discussion

Key findings:

  • left unicornuate uterus without rudimentary horn
  • patent left fallopian tube
  • morphologically normal ovaries with distant positioning of the right ovary anterior to the iliopsoas
  • malrotated and dysplastic right pelvic kidney

This patient has a unicornuate uterus, which resulted from normal development of the left mullerian duct and arrested development of the right mullerian duct. 40% are associated with renal anomalies ipsilateral to the rudimentary horn.

As in this case, absent rudimentary horn subtype presents minimal risk and does not require surgical intervention. Endometrial tissue within a non-communicating rudimentary horn is an important clinical finding that puts the patient at risk for endometriosis, and can be determined with MRI or ultrasound.

HSG can identify a unicornuate uterus, but is not sufficient to exclude the presence of an noncommunicating rudimentary horn. Thus, MRI was performed to complete the anatomic evaluation. 

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