Case: 181

Complete Septate Uterus

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History: 32 yo female with h/o multiple miscarriages.
Solution: 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)). 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 as we see in this case, which can have a fibrous or muscular septum that extends to variable degrees distally within the uterus and/or upper vagina. In this case, there is a thin fibrous septum that extends down to the cervix, but does not involve the vagina. The T-shaped uterus associated with DES exposed patients is not seen as frequently any more. The management of each of these different conditions is different, so the diagnosis made on imaging is critical. In this case, the management would likely be hysteroscopy with septal metroplasty.

MR Images

Questions

This would most accurately be described as a failure of:
  • Septal resorption
  • Organogenesis
  • Fusion
  • Migration
This condition is commonly associated with genitourinary anomalies as well.
False
The most likely diagnosis is:
Complete septate uterus.