12. Hipoplasia uterina El diagnóstico se basa en el pequeño tamaño y en la disminución de la distancia intercornual (<2 cm) RM sagital T2: útero pequeño en una mujer de 18a con amenorrea primaria Vestigio de fondo uterino no funcionante
13. Hipoplasia uterina Paciente de 15 a de edad con diagnóstico clínico de agenesia uterina. El US demuestra un cuerno uterino izquierdo con 5mm de grosor endometrial (funcional). La RM coronal T2 fat sat, muestra, además del cuerno uterino izquierdo, un vestigio no funcional del cuerno uterino derecho (flecha larga).
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16. Unicorne HSG: la imagen puede corresponder con unicorne tipo b,c o d.
17. Utero unicorne tipo b RM axial T1fat sat y T2 que muestra un cuerno uterino derecho funcional no comunicante con hematometra. El cuerno izquierdo es normal.
26. Utero bicorne completo US pélvico: fondo uterino con dos cavidades endometriales en dos cuernos separados y septo central a nivel cervical. En imágenes sagitales puede ser difícil distinguir dos cuerpos uterinos separados
27. Utero bicorne parcial Paciente de 12 a de edad . US sagital que demuestra cérvix único. RM coronal T2 caracteriza la presencia de dos cuernos uterinos separados
28. Utero bicorne HSG y RM: Distancia intercornual >4cm, ángulo intercornual >60º, surco por debajo de la línea intercornual. Paciente de 32 a asintomática.
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31.
32. Utero septado completo El septum puede prolongarse hasta el cervix uterino dando el aspecto de dos cavidades, sin embargo, la convexidad del fondo, el ángulo y distancia intercornuales son diagnósticos
33. Utero septado parcial US endovaginal, reconstruccion oblícua coronal en 3D. El septum no llega al cérvix uterino.
36. Utero septado Septado completo, el septo llega al cérvix uterino. El fondo conserva su convexidad
37. Utero septado parcial HSG: Configuración bicorne RM: Miomas en el septo uterino (flecha larga) y pared lateral izquierda, éste último con degeneración quística
38. Utero septado completo Paciente de 34 años con endometrioma en ovario izquierdo e hematosalpinx,. Las MUV pueden asociarse a endometriosis debido a la “menstruación retrógrada”
39. Utero septado completo Paciente de 16 años con hematometra y hematosalpinx izquierda por obstrucción del cuerno uterino ipsilatera
40. Utero septado completo tratado RM: Septado completo HSG: Postoperatorio con configuración uterina normal y doble canal cervical, el cual no se reparó para evitar incompetencia
Figure 1. Development of the uterovaginal canal. Two paired müllerian ducts (yellow lines) grow medially and caudad. Both ducts fuse in the midline to form the uterus and the upper two-thirds of vagina (lateral fusion). The lower third of vagina is formed by fusion of the ascending sinovaginal bulb (red lines) with the müllerian system (vertical fusion). The septum disappears, leaving a single uterovaginal cana The female reproductive system develops from the müllerian ducts, two ducts that originate in embryonal mesoderm lateral to each wolffian duct. The paired müllerian ducts grow in medial and caudal directions. The most cephalad parts of the ducts remain separate and form the fallopian tubes. The lower parts of the ducts fuse (lateral fusion). The midline septum disappears, leaving a single canal: the uterus and upper two-thirds of the vagina. The lower third of the vagina is formed from the ascending sinovaginal bulb, which fuses with the lower müllerian system (vertical fusion) ( Fig 1) (6-8). The entirely separate origin of the ovaries from the gonadal ridge explains the infrequent association of uterovaginal anomalies with ovarian anomalies (6). The close developmental relationship of the müllerian and wolffian ducts explains the frequent association of anomalies of the female genital system and urinary tract (6). Renal anomalies associated with uterovaginal anomalies include renal agenesis, ectopic kidney, cystic dysplasia, and a duplicated collecting system. The associated renal anomaly is ipsilateral to the abnormally developed müllerian duct, since both are dependent on adequate development of the mesonephric system (6,9
Classification of subtypes of congenital abnormalities of the female reproductive system is important in the treatment of infertility and symptoms arising from obstruction or deformity (10). Many classifications of uterine anomalies exist; for instance, the Buttram and Gibbons classification (16) and the American Fertility Society (AFS) classification (17). We adopted the modified AFS classification by Rock and Adam (18) because it embraces a broader collection of uterine and vaginal anomalies without the conflicting observations or oversimplicity encountered in other classifications. This classification has merit because it correlates anatomic anomalies with embryologic arrests. Accordingly, uterovaginal anomalies are categorized as dysgenesis disorders or vertical or lateral fusion defects. Anomalies are further subcategorized into obstructive or nonobstructive forms, since their treatment differs. Obstructive uterovaginal anomalies require immediate attention because of retrograde flow of trapped mucus and menstrual blood and increasing pressure on surrounding organs, while immediate treatment is not warranted for nonobstructive forms. Because genital tract aberrations do not necessarily follow any defined and consistent pattern, class 4 is a useful addition embracing any possible unusual configurations or combination of defects. Class 1.—Dysgenesis of müllerian ducts. This class includes agenesis or hypoplasia of the müllerian duct derivatives: the uterus and upper two-thirds of the vagina. The most common form is the Mayer-Rokitansky-Kuster-Hauser syndrome, which is combined agenesis of the uterus, cervix, and upper portion of the vagina.Class 2.—Disorders of vertical fusion. These anomalies are due to failure of fusion of the müllerian system with the sinovaginal bulb. They include cervical dysgenesis and obstructive and nonobstructive transverse vaginal septa.Class 3.—Disorders of lateral fusion. This class describes anomalies that result in a duplicated or partially duplicated reproductive tract. The disorders are due to impaired fusion and/or septal resorption of fusing müllerian ducts attempting to form the uterus, cervix, and upper vagina. It includes anomalies due to failure of fusion of the paired müllerian ducts (as in didelphic and bicornuate uteri) and failure of midline septum resorption after fusion (as in septate uterus). Disorders due to lateral fusion defects are further subclassified into (a) the symmetric nonobstructive form seen in five types: unicornuate, bicornuate, didelphic, septate, and DES-related uteri and (b) the asymmetric obstructive form seen in three types: unicornuate uterus with obstructed horn, double uterus with unilaterally obstructed horn, and double uterus with unilaterally obstructed vagina.Class 4.—Unusual configurations and combinations of defects.
Figure 10.American Fertility Society classification of mu ̈ llerian duct anomalies. DES diethylstilbestrol, uterus may be normal or take a variety of abnormal forms, may have two distinct cervices. (Reprinted, with per- mission, from reference 17.)
Class 1.—Dysgenesis of müllerian ducts. This class includes agenesis or hypoplasia of the müllerian duct derivatives: the uterus and upper two-thirds of the vagina. The most common form is the Mayer-Rokitansky-Kuster-Hauser syndrome, which is combined agenesis of the uterus, cervix, and upper portion of the vagina
Figure 9a. Mayer-Rokitansky-Kuster-Hauser syndrome (class 1). (a) Sagittal T2-weighted FSE image (4,000/104) documents the absence of uterine tissues. A concurrent mature pelvic cystic teratoma (MCT) is noted. (b) Axial T2-weighted FSE image (4,000/104) shows absence of vaginal tissue between the bladder (B) and the rectum (R).
Figure 8. Uterine hypoplasia (class 1). Sagittal T2-weighted spin-echo image (4,000/98) shows a small uterus with poorly developed zonal anatomy (arrow) in an 18-year-old woman with primary amenorrhea.
Figure 1.Müllerian agenesis or hypoplasia (class I MDA). (a) Drawing illustrates müllerian agenesis or hypoplasia with a functional müllerian remnant. (b–d) Left functional uterine remnant (class I-E) in a 15-year-old girl with surgically diagnosed Mayer-Rokitansky-Küster-Hauser syndrome. (b) Longitu- dinal US image shows the left uterine horn containing a 5-mm endometrial stripe (arrow). (c) Coronal fast spin-echo T2-weighted MR image shows a left-sided functional uterus (short arrow) with an abnor- mal connection to the cervix. On the right side, a rounded soft-tissue mass is seen (long arrow), with a signal intensity similar to that of the myometrium and no endometrial line.The mass appears to be a right-sided uterine remnant. The vagina is atretic. (d) Laparoscopic image shows the left-sided uterus.
Figure 18. Unicornuate uterus. HSG image shows fusiform configuration of opacified en- dometrial cavity (arrow), with opacification of one fallopian tube
Figure 2.Unicornuate uterus (class II MDA). (a) Drawing illustrates a unicornuate uterus. (b–d) Sur- gically diagnosed unicornuate uterus (class II-B) in a 14-year-old girl with a noncommunicating right uter- ine horn. (b, c) Axial fat-saturated fast spoiled gradient-echo T1-weighted (b) and fast recovery fast spin- echo T2-weighted (c) MR images show an obstructed functional right uterine horn (long straight arrow) containing blood degradation products, with no communication with the cavity of the normal left uterine horn (short straight arrow).This cavity communicates with a normal cervix (curved arrow in c), which in turn communicates with a normal vagina. (d) Laparoscopic image shows a distended right uterine horn (long arrow) and the normal left uterine horn (short arrow).
Symmetric nonobstructive form of lateral fusion defectsUnicornuate uterus.— A unicornuate uterus is banana-shaped and slender, without the usual rounded fundal contour, and is usually laterally deviated. Although the corpus uterus is generally smaller than the nulliparous uterus, the size discrepancy is not great (Fig 12). If present, a solid rudimentary horn can be observed as a soft-tissue mass with signal intensity similar to that of myometrium (2,9,15). Figure 12a. Simple left unicornuate uterus associated with right renal agenesis (class 3). (a) Axial T2-weighted FSE image (2,000/120) shows a laterally deviated banana-shaped uterus (arrow). No rudimentary horn could be detected. (b) Coronal T1-weighed spin-echo image (500/8) with large FOV (45cm) shows right renal agenesis.
Duplicación parcial o total del tracto reproductivo. Falla en la fusión y o reabsorción septal de la fusión de los conductos Mullërianos al intentar formar el utero, cérvix y vagina proximal Class 3.—Disorders of lateral fusion. This class describes anomalies that result in a duplicated or partially duplicated reproductive tract. The disorders are due to impaired fusion and/or septal resorption of fusing müllerian ducts attempting to form the uterus, cervix, and upper vagina. It includes anomalies due to failure of fusion of the paired müllerian ducts (as in didelphic and bicornuate uteri) and failure of midline septum resorption after fusion (as in septate uterus). Disorders due to lateral fusion defects are further subclassified into (a) the symmetric nonobstructive form seen in five types: unicornuate, bicornuate, didelphic, septate, and DES-related uteri and (b) the asymmetric obstructive form seen in three types: unicornuate uterus with obstructed horn, double uterus with unilaterally obstructed horn, and double uterus with unilaterally obstructed vagina.
Didelphic uterus.—Two uterine bodies and two cervices are present in didelphic uterus. The uterine horns are widely splayed with a deep fundal cleft, and the intercornual angle is more than 60°. The endometrial and myometrial zonal widths are preserved (Fig 16). Vaginal septa are most commonly associated with this type of uterine anomaly Figure 16. Didelphic uterus (class 3). Axial T2-weighted spin-echo image (5,000/98) shows fully developed, widely splayed double uteri with two cervices.
Figure 3.Uterus didelphys (class III MDA). (a) Drawing illustrates uterus didelphys. (b–d) Surgically diagnosed uterus didelphys in a 14-year-old girl with an obstructed right hemivagina and ipsilateral renal agenesis. (b) Axial fast spin-echo T2-weighted MR image shows a large hematocolpos centrally (long straight arrow), a finding that corresponds to the obstructed right hemivagina. Mild dilatation of the right endometrial cavity (curved arrow) and a nondistended left endometrial cavity (short straight arrow) are also seen. (c) Coronal fast spin-echo T1-weighted MR image shows a solitary left kidney. (d) Intraoperative photograph shows a bulging right-sided vaginal mass.
Class 4.—Unusual configurations and combinations of defects MR imaging can display the morphology of unusual uterovaginal anomalies. An example is a case of didelphic uterus and longitudinal vaginal septum (lateral fusion defect) combined with obstructed hymen (vertical fusion defect) (Fig 19) (4).
Figure 15.MR images of bicornuate uterus. Fast spin-echo T2-weighted images in (a) coronal oblique (5650/105) and (b) transverse (6000/130) planes provide two examples of bicornuate uteri and demonstrate wide divergence of uterine horns, with communication of endometrial cavities in the lower uterine body (arrow).
Bicornuate uterus.—Two uterine bodies and a single cervix are present in bicornuate uterus. The fundal cleft is greater than 1 cm in depth. The cleft is best visualized on oblique long-axis images of the uterus. The intercornual distance is increased (>4 cm) in bicornuate uteri. The tissue separating the two horns usually demonstrates signal intensity identical to that of myometrium with all pulse sequences (Fig 15) (2,13,19). Bicornuate bicollis is a term that describes a bicornuate uterus with double cervices. It can be distinguished from didelphic uterus because some degree of fusion has occurred between the lower uterine segments (15). Arcuate uterus with a convex or flat external contour and a mild impression on the endometrial cavity is considered the mildest form of bicornuate uterus (13). Figure 15. Bicornuate uterus (class 3). Oblique long-axis T2-weighted spin-echo image (4,000/12) shows double uterine bodies and a single cervix. The fundus is deeply notched (arrow) with a large intercornual distance (5.5 cm). The intercornual angle is also large. The ovaries are well displayed bilaterally.
␣␣␣␣␣␣ ␣␣ Complete bicornuate uterus (class IV-A MDA). (a) Drawing illustrates a complete bicornuate uterus. (b, c) Incidentally discovered complete bicornuate uterus in a 1-year-old girl. (b) Transaxial US image shows divergent endometrial cavities (arrows) in a prepubertal bicornuate uterus. (c) Transaxial US image shows two cervixes (curved arrows) and a septum that extends to the internal os (straight arrow). (d) Complete bicornuate uterus in a 13-year-old girl who presented with dysmenorrhea.Transaxial US image shows a postpubertal bicornu- ate uterus with two separate endometrial cavities: one on the right (long arrow) and one on the left (short arrow).
Figure 5.Partial bicornuate uterus (class IV-B MDA). (a) Drawing illustrates a partial bicornuate uterus. (b, c) Partial bicornuate uterus in a 12-year- old girl. (b) Coronal fast spin-echo MR image shows a large notch (straight arrow) between two separate uterine horns (curved arrows). (c) Longi- tudinal US image shows a solitary cervix.
Fig. 7. Bicornuate-septate uterus by hysterosalpingography (A) and MR imaging (B). The indentation of the serosal contour of the uterine fundus though small makes this technically bicornuate uterus, and likely not clinically significant. Correct categorization and determination of significance of uterine anomalies is debated by fertility specialists.
Class 4.—Unusual configurations and combinations of defects MR imaging can display the morphology of unusual uterovaginal anomalies. An example is a case of didelphic uterus and longitudinal vaginal septum (lateral fusion defect) combined with obstructed hymen (vertical fusion defect) (Fig 19) (4).
Septate Uterus—The outer fundal contour is convex or flat or has a slight indentation less than 1 cm deep. The intercornual distance is within the normal range. The intercornual angle measures less than 60°. These findings are best seen in oblique long-axis images (Fig 13) (2). The uterine septum may be composed of muscle or fibrous tissue. A muscular septum has intermediate signal intensity with all pulse sequences, isointense to myometrium. A fibrous septum usually has a lower intensity with all sequences. The muscular or fibrotic nature of an intracavitary septum is assessed more on the basis of septal thickness than on signal intensity; the fibrous septum is thin and linear. Mixed muscular and fibrous septa have also been described (13). If the septum reaches the internal os, it is complete (Fig 14); if it terminates above the internal os, it is a partial septum (19). Figure 13a. Septate uterus: incomplete septum (class 3). Multiple images in different planes were obtained in the same patient. The solid red line in the right-lower-corner inset indicates the plane of section. (a) Direct coronal T2-weighted FSE image (5,000/96) shows double uteri but has limited value in evaluation of the fundus. (b, c) Oblique long-axis T2-weighted FSE images (4,000/96) obtained parallel to the long axis of the uterus show the convex external contour of the fundus (arrow in b). The intercornual distance (dotted line) is 3.5 cm. The intercornual angle between the distal ends of the horns is less than 60° (intersecting lines). The uterine septum is thick and isointense to myometrium, which indicates it is muscular. The lower extent of the uterine septum in the cervical canal is unclear (? arrow). (d) Oblique short-axis T2-weighted FSE image (4,000/96) of the cervix obtained perpendicular to the long axis of the uterus (dotted line in inset) shows a single cervical canal. The arrowhead points to normal infolding of the cervix seen in many cases without associated anomalies.
Septate Uterus—The outer fundal contour is convex or flat or has a slight indentation less than 1 cm deep. The intercornual distance is within the normal range. The intercornual angle measures less than 60°. These findings are best seen in oblique long-axis images (Fig 13) (2). The uterine septum may be composed of muscle or fibrous tissue. A muscular septum has intermediate signal intensity with all pulse sequences, isointense to myometrium. A fibrous septum usually has a lower intensity with all sequences. The muscular or fibrotic nature of an intracavitary septum is assessed more on the basis of septal thickness than on signal intensity; the fibrous septum is thin and linear. Mixed muscular and fibrous septa have also been described (13). If the septum reaches the internal os, it is complete (Fig 14); if it terminates above the internal os, it is a partial septum (19). Figure 13a. Septate uterus: incomplete septum (class 3). Multiple images in different planes were obtained in the same patient. The solid red line in the right-lower-corner inset indicates the plane of section. (a) Direct coronal T2-weighted FSE image (5,000/96) shows double uteri but has limited value in evaluation of the fundus. (b, c) Oblique long-axis T2-weighted FSE images (4,000/96) obtained parallel to the long axis of the uterus show the convex external contour of the fundus (arrow in b). The intercornual distance (dotted line) is 3.5 cm. The intercornual angle between the distal ends of the horns is less than 60° (intersecting lines). The uterine septum is thick and isointense to myometrium, which indicates it is muscular. The lower extent of the uterine septum in the cervical canal is unclear (? arrow). (d) Oblique short-axis T2-weighted FSE image (4,000/96) of the cervix obtained perpendicular to the long axis of the uterus (dotted line in inset) shows a single cervical canal. The arrowhead points to normal infolding of the cervix seen in many cases without associated anomalies.
Figure 14. Complete septate uterus (class 3). Oblique long-axis T2-weighted FSE image (4,000/96) shows a septate uterus with a complete septum extending to the external os. The septum is thin and has low signal intensity, which indicates it is fibrous.
Figure 6.Coronal oblique reconstructed three- dimensional endovaginal US image of a partial uterine septum demonstrates mild indentation of the uterine fundus with no intervening cleft (short arrow) and septum separating endome- trial cavities (long arrow). (Image courtesy of Anna Lev-Toaff, MD, Thomas Jefferson Uni- versity, Philadelphia, Pa.)
Figure 7.Classification criteria for US differentiation of septate from bicornuate uteri. A, When apex (3) of the fundal external contour occurs below a straight line between the tubal ostia (1, 2) or, B, 5 mm (arrow) above it, the uterus is bicornuate. C, When apex is more than 5 mm (arrow) above the line, uterus is septate.
MR images of complete uterine septum. (a) Transverse oblique fast spin-echo T2- weighted image (7150/120) shows convex external uterine contour with upper myometrial segment (short arrow) and lower fibrous segment (long arrow) extending to external uterine os. (b) Transverse fast spin-echo T2-weighted image (6000/115) shows vertical septum extending to upper third of vagina (arrow). (Reprinted, with permission, from reference 43.)
Figure 6.Septate uterus (class V MDA). (a) Drawing illustrates a complete septate uterus. (b–d) Surgically diagnosed complete septate uterus (class V-A) in a 15-year-old girl. (b) Transverse US image shows a solid mass (arrow) between two endometrial canals.The echotexture of the mass is compatible with that of myome- trium. Scale is in centimeters. (c) Axial fast spin-echo T2-weighted MR image shows the fundus of the uterus and two cervixes. A septum (arrow) is seen to extend through the cervix. (d) Laparoscopic image shows the external fundal contour.
Figure 5. simulating a bicornuate configuration. (b) Corresponding coronal oblique fast spin-echo T2- weighted MR image (6000/120 [effective]) demonstrates insinuated leiomyoma (long arrow) within the septum, causing exaggerated separation of cavities. Note lateral wall myoma with cystic degeneration (short arrow) also causing distortion of left endometrial cavity.eptate uterus. (a) HSG image shows wide divergence of opacified endometrial cavities
␣␣␣␣␣␣ ␣␣ Septate uterus (class V MDA). (a) Drawing illustrates a complete septate uterus with an obstructed left side. (b–d) Surgically diagnosed complete septate uterus (class V-A) in a 16-year-old girl with an obstructed left uterine horn and left hematosalpinx. (b) Longitudinal US image shows the hematosalpinx (arrows). (c) Axial fast spin-echo T2-weighted MR image shows the hematosalpinx (long straight arrow) and an obstructed left uterine cavity (short straight arrow), as well as an unobstructed right uterine horn (curved arrow). (d) Postoperative hysteroscopic image shows that the previously ob- structed cavity is no longer obstructed.
Fig. 8. Septate uterus. (A) Complete uterine and cervical septum by MR imaging. (B) Postoperative hysterosalpingogram demonstrates normal cavity after resection of uterine septum; cervical septum was not resected to avoid incompetent cervix. Two cervical canals are demonstrated (arrows).
Class 4.—Unusual configurations and combinations of defects MR imaging can display the morphology of unusual uterovaginal anomalies. An example is a case of didelphic uterus and longitudinal vaginal septum (lateral fusion defect) combined with obstructed hymen (vertical fusion defect) (Fig 19) (4).
Figure 11.Diagram of ar- cuate uterus ratio. When ra- tio of height (H) to length (L) is less than 10%, an ad- verse reproductive outcome is not expected. (Reprinted, with permission, from ref- erence 63.) 12. Arcuate uterus. HSG image dem- onstrates broad fundal indentation (arrow). Figure 13. Arcuate uterus. Transverse fast spin-echo T2-weighted MR image (6166/130) demonstrates nonspecific low signal intensity of fundal myometrium (arrow).
Figure 8.Arcuate uterus (class VI MDA). (a) Drawing illustrates an arcuate uterus. (b–d) Arcuate uterus in a 14-year-old girl. (b) Longitudinal US image shows the uterus (cursors) with a flat fundal contour (long arrow), a single endometrial cavity, and a hypoplastic cervix (short arrow). (c) Coronal fast spin-echo T2-weighted MR image also shows a flat fundal contour (short arrow) and a hypoplastic cervix (long arrow). (d) Axial fast spin-echo T2- weighted MR image shows a postpubertal uterus with a single cavity (arrow).
Class 4.—Unusual configurations and combinations of defects MR imaging can display the morphology of unusual uterovaginal anomalies. An example is a case of didelphic uterus and longitudinal vaginal septum (lateral fusion defect) combined with obstructed hymen (vertical fusion defect) (Fig 19) (4).
Fig 23: DES exposure. HSG image shows T configuration of endometrial cavity (ar-row). Diethylstilbestrol is a synthetic nonsteroidal es- trogen that, until 1971, was often given during pregnancy to prevent miscarriages in women who had had previous miscarriages. However,diethylstilbestrol was found to be associated with vaginal clear cell carcinoma, an extremely rare tumor, in girls with prior intrauterine ex- posure to this drug. Structural anomalies of the uterine corpus, cervix, and vagina were subse- quently described in girls and women with in- trauterine diethylstilbestrol exposure. Use of the drug was banned over 30 years ago, and these anomalies are rarely seen today. In addition, be- cause affected women typically do not present with an obstruction, diethylstilbestrol-related anomalies are considered beyond the scope of this article.
DES exposure. (a, b) Coronal oblique fast spin-echo T2-weighted MR images (6750/105) show T configuration, constriction bands (long arrows), and cavitary narrowing (short arrows).
Fig. 6. Unicornuate uterus by hysterosalpingography (A) and MR imaging (B). Note the nonfunctioning rudimentary horn (arrow).
Figure 4.HSG demonstration of septate versus bicornuate uteri. (a) Acute angle of divergence between uterine horns is most suggestive of a septate uterus (arrow). (b, c) Indeterminate angles of divergence may suggest either (b) septate uterus (arrow) or (c) bicornuate uterus (arrow). Final diagnoses were based on subsequent MR imaging results (not shown).
Uterus didelphys. (a, b) HSG images show catheterization of two separate cervices with opacification of two widely divergent noncommunicating endometrial cavities (arrow) Uterus didelphys. (a, b) Transverse fast spin-echo T2-weighted MR images (7216/ 130) show complete duplication of uterine horns (short arrows), with partial degree of fusion of adjacent cervices (long arrows).Figure 17.
Bicornuate uterus. (a) Transverse US image and (b) corresponding transverse oblique fast spin-echo T2-weighted MR image (7250/105) demonstrate external fundal cleft (straight arrow) with wide divergence of endometrial cavities. Note leiomyoma (curved arrow) in right lateral wall.Figure 14.
Transverse vaginal septum.—A transverse vaginal septum could be in a high, middle, or low position. It is more common in the upper vagina. Figure 10. Transverse vaginal septum (class 2). Sagittal T2-weighted spin-echo image (4,000/98) shows a transverse septum in the middle of the vagina (arrow), causing dilatation of the proximal vagina (V) and uterus (U) (hematocolpos and hetmatometria).
Figure 9.Transverse vaginal septum (class I vaginal septum anomaly). (a) Drawing illustrates a transverse vaginal septum. (b–d) Surgically diagnosed low transverse vaginal septum in a 14-year-old girl. (b) Photo- graph obtained prior to surgical drainage of a large hematocolpos shows a low vaginal septum, as well as a thick pink membrane extending into the introitus. (c) Longitudinal US image shows the hematocolpos (ar- row). (d) Sagittal fast spin-echo T2-weighted MR image shows a blood-filled vagina (long arrow) and a nor- mal uterus (short arrow).
Figure 10.Longitudinal vaginal septum (class II vaginal septum anomaly). (a) Drawing illustrates a longitudinal vaginal septum. (b, c) Complete longitudinal vaginal septum in a 13-year-old girl with uterus didelphys and a right-sided vaginal obstruction. (b) Longitudinal US im- age shows a right hematocolpos containing debris (arrow). (c) Coronal fast spin-echo proton-density–weighted MR image shows an unobstructed vagina (long arrow). Short arrow indicates the hematocolpos.
Figure 11.Imperforate hymen. (a) Drawing illustrates an imperforate hymen. (b–d) Surgically diagnosed imperforate hymen in a 14-year-old girl with primary amenorrhea. (b) Photograph (lateral view) shows a pro- tuberant lower abdomen. (c) Photograph of the vulva shows a bulging bluish vaginal membrane. (d) Sagittal reformatted CT image shows a large hematometrocolpos (arrow).
Figure 19a. Didelphic uterus and longitudinal vaginal septum combined with obstructed hymen (class 4). (a) Direct coronal T1-weighted spin-echo image (420/6) shows a markedly distended vagina with altered blood products (hematocolpos); obstruction is at the level of the hymen (arrow). A longitudinal septum (arrowhead) splits the vagina into two compartments, sparing its lowest part, which has a different embryologic origin. (b) Sagittal T2-weighted FSE image (4,000/98) shows that the uterus is connected to each vaginal compartment (only one side is shown).
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