History: 34 yo female with infertility.
Solution: Uterine anomalies.
Patients with uterine (or müllerian duct) anomalies have a higher incidence of infertility, recurrent first-trimester abortions, intrauterine growth retardation, preterm labor, fetal malpositioning, and retained placenta. They fall into three main categories based upon the underlying problem. If it is a defect in organogenesis, then the organ, or half of it won\'t be there (i.e. uterine agenesis or hypoplasia (bilateral) or unicornuate uterus (unilateral)) as we see in this case. If there is a defect in normal fusion of the paired mullerian ducts, then you end up with duplicated uteri to various degrees (i.e. uterine didelphys or bicornuate uterus). If on the other hand, it is secondary to lack of septal resorption, then the end result is a septate uterus, which can have a fibrous or muscular septum that extends to variable degrees distally within the uterus and/or upper vagina. The T-shaped uterus associated with DES exposed patients is not seen as frequently any longer. The management of each of these different conditions is different, so the diagnosis made on imaging is critical.
Patients with uterine (or müllerian duct) anomalies have a higher incidence of infertility, recurrent first-trimester abortions, intrauterine growth retardation, preterm labor, fetal malpositioning, and retained placenta. They fall into three main categories based upon the underlying problem. If it is a defect in organogenesis, then the organ, or half of it won\'t be there (i.e. uterine agenesis or hypoplasia (bilateral) or unicornuate uterus (unilateral)) as we see in this case. If there is a defect in normal fusion of the paired mullerian ducts, then you end up with duplicated uteri to various degrees (i.e. uterine didelphys or bicornuate uterus). If on the other hand, it is secondary to lack of septal resorption, then the end result is a septate uterus, which can have a fibrous or muscular septum that extends to variable degrees distally within the uterus and/or upper vagina. The T-shaped uterus associated with DES exposed patients is not seen as frequently any longer. The management of each of these different conditions is different, so the diagnosis made on imaging is critical.
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