Figure 1
Axial Sequence T2 FS
Axial Sequence T2 FS shows two divided uteruses with each cervices
The failure of fusion of Mullerian ducts with Uterus Didelphys and Vaginal duplication.
SectionGenital (female) imaging
Case TypeAnatomy and Functional Imaging
Authors
Allajbeu I1, Dhima A1, Isufi E1, Peci E2.
1) Dept. of radiology; 2) Dept. of Gynaecology; American Hospital, Tirana, Albania.
Connected authors
15 years, female
Clinical History
A 15 year old girl presented to our hospital because of bilateral lumbar and pelvic pain.
Imaging Findings
A 15 year old girl presented to our hospital because of bilateral lumbar and pelvic pain. During two months, the patient had pain with variable intensity that was not related to menstrual cycle. The menstrual cycle was normal but with no complete outflow. The patient underwent echography and MRI examinations and was diagnosed as a congenital uteri anomaly, uterus didelphys with imperforated hemivagina and right renal and urinary tract agenesis.
Discussion
Uterus didelphys with imperforated hemivagina is an embryonic malformation that happens during the 12-16th week of embryonic life. This malformation is caused by the impossibility of fusion of the paramesonephric (Mullerian) ducts and is manifested in a duplication of all the female reproductive system.
1. Two separated uteri, which can be joined in the body.
2. Without any communication between two endometrial clearances with saved endometrial/miometrial rate in each uterus
3. Double cervices
4. Longitudinal or oblique vaginal septum always present (that creates two hemivagina)
The obstruction of one hemivagina blocks the outflow that results in complications such as hematocolpos, hematometra and hematosalpinx. The persistence of this situation also may be complicated by the occurrence of endometriosis as a result of blood reflux into the abdominal cavity. This anomaly is often accompanied by kidney and urinary tract malformation (Agenesis, dysplasia, collecting system duplication, ectopic uterus). The perforated hemivagina is usually accompanied by ipsilateral renal agenesis (of the same side).
The symptoms usually start only after menarche and are accompanied by dysmenorrhoea, severe abdominal pain and a palpable pelvic mass. Echography is the first imaging method and it can identify two uteri, hematocolpos and the presence or not of unilateral renal agenesis.
MR is the essential imaging method as in the case when echography is not conclusive and if echography confirms the doubt. It gives accurate data referring to the diagnosis to obtain definitive pre-operative confirmation, and a multiplanar anomaly reproduction.
MR is a non-invasive imaging method which allows an early and limited surgical treatment, substituting explorative laparotomic or laparoscopic procedures.
1. Two separated uteri, which can be joined in the body.
2. Without any communication between two endometrial clearances with saved endometrial/miometrial rate in each uterus
3. Double cervices
4. Longitudinal or oblique vaginal septum always present (that creates two hemivagina)
The obstruction of one hemivagina blocks the outflow that results in complications such as hematocolpos, hematometra and hematosalpinx. The persistence of this situation also may be complicated by the occurrence of endometriosis as a result of blood reflux into the abdominal cavity. This anomaly is often accompanied by kidney and urinary tract malformation (Agenesis, dysplasia, collecting system duplication, ectopic uterus). The perforated hemivagina is usually accompanied by ipsilateral renal agenesis (of the same side).
The symptoms usually start only after menarche and are accompanied by dysmenorrhoea, severe abdominal pain and a palpable pelvic mass. Echography is the first imaging method and it can identify two uteri, hematocolpos and the presence or not of unilateral renal agenesis.
MR is the essential imaging method as in the case when echography is not conclusive and if echography confirms the doubt. It gives accurate data referring to the diagnosis to obtain definitive pre-operative confirmation, and a multiplanar anomaly reproduction.
MR is a non-invasive imaging method which allows an early and limited surgical treatment, substituting explorative laparotomic or laparoscopic procedures.
Differential Diagnosis List
Mullerian ducts anomalies with Uterus Didelphys and Vaginal duplication.
Final Diagnosis
Mullerian ducts anomalies with Uterus Didelphys and Vaginal duplication.
References
[1] Mueller GC, Hussain HK, Smith YR, Quint EH, Carlos RC, Johnson TD, DeLancey JO (2007) Müllerian Duct Anomalies: Comparison of MRI Diagnosis and Clinical Diagnosis. AJR Am J Roentgenol 189(6):1294-302. (PMID: 18029861)
[2] Dykes TM, Siegel C, Dodson W (2007) Imaging of Congenital Uterine Anomalies: Review and Self-Assessment Module. AJR Am J Roentgenol 189(3 Suppl):S1-10. (PMID: 19642254)
[3] Failure of fusion of the paramesonephric (Mullerian) ducts with uterus didelphys and vaginal duplication. Eurorad 2006.
[4] Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P (2001) Clinical implications of uterine malformation and hysterscopic treatment results. Hum Reprod Update 7(2):161-74. (PMID: 11284660)
[5] Madureira AJ, Mariz CM, Bernardes JC, Ramos IM (2006) Case 94: Uterus Didelphys with Obstructing Hemivaginal Septum and Ipsilateral Renal Agenesis. Radiology 239(2):602-6. (PMID: 16641359)
Case information
| URL: | https://www.eurorad.org/case/7773 |
| DOI: | 10.1594/EURORAD/CASE.7773 |
| ISSN: | 1563-4086 |
Figure 2
Axial Sequence T1 Fs
Axial Sequence T1 Fs shows right hemivagina dilatation with high signal that suggests blood contents. The left hemivagina is compressed.
Figure 3
Coronal Sequence T2 Fs
Coronal Sequence T2 Fs shows right renal and urinary tract agenesis.
Figure 4
Sagittal Sequence T1 Vibe Fs
Sagittal Sequence T1 Vibe Fs shows right dilated hemivagina with right uterus clearance dilatation that suggests hematocolpos. Compressed urinary bladder.
Axial Sequence T2 FS
Axial Sequence T2 FS shows two divided uteruses with each cervices
Axial Sequence T1 Fs
Axial Sequence T1 Fs shows right hemivagina dilatation with high signal that suggests blood contents. The left hemivagina is compressed.
Coronal Sequence T2 Fs
Coronal Sequence T2 Fs shows right renal and urinary tract agenesis.
Sagittal Sequence T1 Vibe Fs
Sagittal Sequence T1 Vibe Fs shows right dilated hemivagina with right uterus clearance dilatation that suggests hematocolpos. Compressed urinary bladder.