Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Synovial Sarcoma
Joseph Junewick, MD FACR
over 8 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Uterine Didelphys

Case Detail

Anatomy: Genitourinary
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: MR
Adobe32 PDF Imagej32 ImageJA


Young adult with pelvic pain.

Case Images


Uterine Didelphys


MR – Separate right and left uterine horns, cervixes and viaginas with right hydrocolpos.


The female genital system is derived from the paired paramesonephric (mullerian) ducts. The paramesonephric ducts develop bidirectionally along the lateral aspects of the gonads. The proximal segments of the uterovaginal canal remain unfused and open into the peritoneal cavity to form the fallopian tubes. The distal segments progress caudomedially and join each other before contacting the posterior aspect of the pelvic urethra at the level of the sinusal tubercle. These distal segments of the uterovaginal canal give rise to the uterus and upper four-fifths of the vagina.

Uterine didelphys is the result of nearly complete failure of fusion of the müllerian ducts and accounts for about 5% of mullerian duct anomalies. Each müllerian duct develops its own hemiuterus and cervix and demonstrates normal zonal anatomy often with some degree of fusion at the level of the cervices; no communication is present between the duplicated endometrial cavities. A longitudinal vaginal septum is associated in 75% of these anomalies which may be be complicated by hematometrocolpos. Complications include spontaneous abortion, premature birth and poor fetal survival rates.

MR imaging demonstrates two separate uteri with widely divergent apices, two separate cervices, and usually an upper vaginal longitudinal septum. In each uterus, the endometrial-to-myometrial width and ratio are preserved, as is normal uterine zonal anatomy. An obstructed unilateral vaginal septum may cause apparent marked deformity of the uterus according to the degree of associated hematometrocolpos. Ipsilateral renal agenesis may be seen on the side of hematometrocolpos.


Troiano RN, McCarthy SM. Mullerian duct anomalies: Imaging and clinical issues. Radiology 2004; 233(1):19-34.


Andrew Shin, MD

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare