Presentation
Unscheduled bleeding on HRT. On EUA, the patient has 2 uterine cervices, neither of which could be accessed for endometrial biopsy. Opinion please regarding uterine anatomy and whether any endometrial abnormality evident.
Patient Data
Uterine didelphys - retroverted cervices. Deep bilateral lateral vaginal fornices.
Thin endometrial stripes bilaterally. No obvious endometrial abnormality identified.
Normal appearance of both ovaries.
A trace of free fluid is seen adjacent to the posterior aspect of the left uterine horn - this may be hormone-related as tiny follicles are still present in the left ovary.
Case Discussion
Uterus didelphys is when the uterus is present as a paired organ secondary to the failed embryogenetic fusion of the Mullerian ducts. Each uterus has a single horn linked to the ipsilateral fallopian tube and ovary. Complications occur during pregnancy with premature birth and malpresentation.
Diagnosis is commonly initially made with ultrasound and confirmed on MRI due to the lack of ionizing radiation.
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