IS Case 211: Bicornuate uterus

Charles Hubeny, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is a 26-year-old female with infertility.

Findings

Findings are consistent with a bicornuate uterus.

Diagnosis

Bicornuate uterus

Discussion

Congenital anomalies occasionally occur and may either be a result of the environment (DES exposure) or genetically as some anomalies follow family lines. There are seven types of uterine anomalies and classification is based on the shape and morphology of the uterus that results from either failure of müllerian duct formation, fusion, or resorption of the median septum after fusion.

  1. Hypoplasia/Agenesis: Failure of both müllerian ducts to form resulting in lack of fallopian tubes, uterus, cervix, and top 1/3 of the vagina.
  2. Unicornate: Failure of one müllerian duct to form resulting in single horn.
  3. Didelphus: Failure of müllerian duct fusion resulting in two separate narrow uterine cavities which may have a shared or separate cervix.
  4. Bicornuate: Failure of fusion of the müllerian ducts cranially resulting in a single uterine cavity at the bottom with single cervix branching superiorly into two horns.
  5. Septate uterus: Failure of median septum resorption resulting in a uterus with normal external shape with two cavities separated by a septum.
  6. Arcuate:; Mild midline indentation from failure of median septum resorption; the uterus is essentially normal in shape.
  7. DES exposure: Daughters of mothers who ingested DES during pregnancy may have a variety of anomalies that range from hypoplastic to a T-shaped uterus or incompletely formed cervix from an unknown mechanism.

A bicornuate uterus is usually diagnosed with HSG or MRI. Findings have to demonstrate divergent uterine horns connecting inferiorly with posterior fundal cleft measuring greater than 1 cm. Unless there is an obstruction the condition is usually asymptomatic. There is no little to no impact on fertility but there is an increased rate of spontaneous abortions and premature deliveries. Cerclage can be performed in those at risk. Metroplasty is an option for those that have recurrent second and third trimester abortions.

References

  1. Troiano RN, McCarthy SM. Müllerian duct anomalies: imaging and clinical issues. Radiology. 2004 Oct;233(1):19-34. [PMID: 15317956]

2 images