Uterine hypoplasia

Case contributed by Mohamed Saber

Presentation

A virgin with primary amenorrhea and less developed secondary sex characters.

Patient Data

Age: 15 years
Gender: Female
ultrasound

Ultrasound study shows a small-sized uterus relative to the patient’s age and poorly delineated endometrium. Both ovaries appear normal.

mri

MRI study shows a small-sized uterus, it measures 1.5x3.2x5.3 cm at its largest thickness (anteroposterior), width (transverse), and length (craniocaudal), respectively. Its volume is 13.3 ml (normal for a 15 year-old is 21.2 ml). The endometrial line is barely visualized along the uterine body and endocervical canal.

The uterine length measures 5.3 cm (normal at the pubertal age is 5-8 cm), the uterine body length measures 3.2 cm, the cervical length measures 2.1 cm, and the uterine body to cervix ratio measures 1.5 (normal at the pubertal age is 1.5-2:1).

Both ovaries appear normal with no dominant follicles.

Annotated image
  • green line - uterine thickness (AP diameter)
  • curved orange line - uterine length (craniocaudal length)
  • blue line - uterine width (transverse diameter)
  • yellow length - uterine body length
  • red line - cervical length

Case Discussion

Here is a case of uterine hypoplasia (infantile uterus/female hypogonadism) that is considered a class I Müllerian duct anomaly.

In this case, the uterine volume is markedly small for the patient’s age. Surprisingly, the uterine length and uterine body to cervical ratio are within normal. Accordingly, it is better to use both methods to reach the right diagnosis.

Further hormonal essay and chromosomal analysis are recommended

For a detailed discussion of uterine measurements, see here.

Ultrasound contribution by Dr. Shereen Ahmed

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