DOI:10.2214/AJR.07.7019
AJR 2007; 189:S11-S12
© American Roentgen Ray Society
AJR Teaching File: Infertility in a Young Woman
Sidhartha Chaudhry1
1 Department of Radiology, University of Pittsburgh Medical Center, 3950 CHP,
200 Lothrop St., Pittsburgh, PA 15213.
Received June 18, 2007;
accepted after revision June 18, 2007.
Address correspondence to S. Chaudhry
(sidhartha.chaudry{at}gmail.com).
Keywords: infertility • MRI • müllerian duct abnormalities • septate uterus
Case History
A 24-year-old woman presents with infertility.
Radiologic Description
An oblique axial T2-weighted MR image
(Fig. 1) through the horizontal
long axis of the uterus shows a muscular septum arising from the fundus and
extending into the body region; the overlying junctional zone is continuous
over the lateral walls of the uterus. The outer contour of the fundus is
flattened, whereas a normal uterine fundus is convex on the outer aspect. The
left ovary seen in this image is unremarkable. The right ovary, seen better on
a different image (not shown), is also normal in appearance.
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Fig. 1 —24-year-old woman with infertility due to septate uterus.
Oblique axial T2-weighted fast spin-echo image shows flat outer fundal contour
and septum that divides uterine cavity into separate horns.
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Differential Diagnosis
The differential diagnosis in this patient is uterus didelphus, bicornuate
uterus, septate uterus, and arcuate uterus.
Diagnosis
The diagnosis is septate uterus.
Commentary
During fetal development, the normal uterus is formed when the distal
segments of the right and left müllerian ducts migrate caudally and
medially and fuse in the midline, forming the embryologic uterovaginal canal.
A residual midline septum subsequently resorbs, starting from the caudal
extent and progressing cephalad, leaving a single lumen. Failure of this
process at any stage results in a variety of congenital uterine
abnormalities.
Varying degrees of failures of fusion result in uterus didelphus and
bicornuate uterus, whereas varying degrees of failure of septal resorption
result in septate uterus and arcuate uterus
[1]. Failures of fusion are
characterized by abnormalities of the external shape of the fundus and the
distance between the uterine horns (intercornual distance). Uterine anomalies
caused by a failure of fusion will show a dip in the outer fundal contour and
an increased intercornual distance, features that can be shown on MRI
[2–4]
(Fig. 1).
When müllerian duct migration and fusion have been successful but
septal resorption has failed, the outer fundal contour and the intercornual
distance will both be relatively normal, as in this case. Therefore, the
persistent uterine septum that results in two separate uterine cavities in
this patient is the result of the failure of septal resorption, and the
diagnosis is septate uterus.
The distinction between septate uterus and bicornuate uterus has important
management implications. In septate uterus, but not in bicornuate uterus, the
septum can be shaved off during hysteroscopy to form a single uterine cavity
without perforating the uterus. Arcuate uterus is a milder form of the septate
uterus, where there is only a convexity towards the luminal side of the
fundus, but no actual septum dividing the uterine cavity.
Objective
The objective of this article is to show the imaging findings of a septate
uterus and to discuss its differentiation with MRI from other müllerian
duct abnormalities.
Conclusion
Septate uterus is characterized on MRI by the presence of a uterine fundus
with relatively normal outer contour and a uterine cavity with normal
intercornual distance, but separated by a septum.
References
- Dykes TM, Siegel C, Dodson W. Imaging of congenital uterine
anomalies: review and self-assessment module. AJR2007; 189[suppl]:S1
–S10[CrossRef]
- Pellerito JS, McCarthy SM, Doyle MB, Glickman MG, DeCherney AH.
Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal
sonography, and hysterosalpingography. Radiology1992; 183:795
–800[Abstract/Free Full Text]
- Reuter KL, Daly DC, Cohen SM. Septate versus bicornuate uteri:
errors in imaging diagnosis. Radiology1989; 172:749
–752[Abstract/Free Full Text]
- Marten K, Vosshenrich R, Funke M, et al. MRI in the evaluation of
müllerian duct anomalies. Clin Imaging2003; 27:346
–350[CrossRef][Medline]
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Case History
Radiologic Description
