AJR 2002; 179:537-538
© American Roentgen Ray Society
Rare Bicornuate Uterus with Fibroid Tumors: Hysterosalpingography-MR Imaging Correlation
Justin Q. Ly
Wilford Hall Medical Center Lackland AFB, TX 78236-5300
Note.—The opinions and assertions contained in the article above are
the private views of the author and are not to be construed as official or as
reflecting the views of the Department of the Air Force or the Department of
Defense.
A 24-year-old woman was referred to our fertility clinic after more than a
year of unsuccessful attempts to become pregnant. She had no children and
reported a history of a prior spontaneous abortion several years earlier. The
findings of the physical examination were unremarkable, and the patient was
otherwise healthy. Hysterosalpingography was performed as part of the initial
fertility workup. The examination revealed a single cervix with two long,
narrow, and widely separated uterine cavities
(Fig. 3A). Although this
appearance is consistent with a bicornuate uterus, a septate uterus could not
be definitively ruled out, prompting further evaluation with MR imaging. The
axial T2-weighted MR images of the pelvis revealed the incidental findings of
two rounded heterogeneous fibroids (Figs.
3B and
3C), each originating from a
separate horn of the uterus.
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Fig. 3A. —24-year-old woman with fibroid tumor involvement at each
bicornuate uterine horn. Frontal hysterosalpingogram shows single cervix and
two long and narrow uterine cavities that are separated by angle of
approximately 80°. Although this appearance is consistent with bicornuate
uterus, it could not be used to definitively rule out possibility of septate
uterus.
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Fig. 3B. —24-year-old woman with fibroid tumor involvement at each
bicornuate uterine horn. Axial T2-weighted MR images of pelvis reveal
incidental findings of two rounded heterogeneous fibroids (arrows),
each one originating from upper aspect of separate uterine horn. B was
obtained inferior to C.
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Fig. 3C. —24-year-old woman with fibroid tumor involvement at each
bicornuate uterine horn. Axial T2-weighted MR images of pelvis reveal
incidental findings of two rounded heterogeneous fibroids (arrows),
each one originating from upper aspect of separate uterine horn. B was
obtained inferior to C.
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Uterine anomalies are congenital malformations caused by fusion or
resorption defects during embryogenesis. The bicornuate uterus is caused by
the incomplete fusion of the two mesonephric ducts and is characterized by an
indented fundus. As a result, the uterine body is divided into right and left
cavities, which join just above or at the cervix. Although not a specific
finding, the angle between the horns of the bicornuate uterus is usually not
more than 105° [1]. The
septate uterus has a normal fundal contour but is characterized by a
persistent longitudinal septum that partially divides the uterine cavity. If
the angle between the uterine cavities is less than or equal to 75°, a
septate uterus is present. If the angle is larger than 75° but less than
105°, it is still probable that the uterus is septate, but sonography
performed during the luteal phase of the patient's menstrual cycle can rule
out the possibility of a bicornuate component. If the angle is equal to or
more than 105°, a bicornuate uterus is probably present; sonography can be
helpful in ruling out the presence of a septum or septal component
[2]. The didelphic uterus is
different from the bicornuate uterus in that it contains not one but two
endometrial and two cervical canals. A unicornuate uterus contains only a
single horn and adnexa that point to either side of the pelvis, and on
transverse images, the uterus appears as a circular structure above the
cervix, with a diameter similar to that of the cervix. Clinically, each of
these congenital malformations can result in infertility and recurrent
miscarriages.
The case of the patient described is rare and interesting in that both
horns of the bicornuate uterus each contained a single fibroid projecting into
the pelvic cavity, which likely contributed to the patient's infertility
problems. To my knowledge, no report of such a case has appeared before in the
literature. MR imaging of the pelvis is an excellent noninvasive modality for
the assessment of the internal and external contours of the uterus
[3]. Moreover, pelvic MR
imaging can aid in differentiating patients who require surgery from those who
do not, which in many cases obviates invasive diagnostic procedures
[4].
References
- Zwiebel WJ. Pelvic congenital anomalies and pubertal disorders. In:
Zwiebel WJ, ed. Introduction to ultrasound.
Philadelphia: Saunders, 1983:294
-296
- Reuter KL, Daly DC, Cohen SM. Septate versus bicornuate uteri:
errors in imaging diagnosis. Radiology
1989;172:749
-752[Abstract/Free Full Text]
- Carrington BM, Hricak H, Nuruddin RN, Secaf E, Laros RK, Hill EC.
Mullerian duct anomalies: MR imaging evaluation.
Radiology
1990;176:715
-720[Abstract/Free Full Text]
- Pellegrito JS, McCarthy SM, Doyle MB, Glickman MG, DeCerney AH.
Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal
sonography, and hysterosalpingography. Radiology
1992;183:796
-800
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