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Joseph Junewick, MD FACR
over 7 years ago
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Uterine Didelphys

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

Young adult with pelvic pain.


Case Images


Diagnosis

Uterine Didelphys

Findings

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

Discussion

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.

Reference

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

Contributor

Andrew Shin, MD



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