müllerian duct anomalies

Uterus
bicornis bicollis mit gemeinsamer Portioöffnung: Das Cavum uteri ist vollständig getrennt, es gibt aber noch gemeinsames Myometrium (sonst Uterus didelphys); Septum in nahezu der kompletten Zervix. MRT T2, links 2 Schichten paracoronar, rechts 3 Schichten axial in verschiedenen Höhen.
Wikipedia • CC BY-SA 4.0
Mature cystic
ovarian teratoma • Septate uterus with ovarian pathologies - Ganzer Fall bei Radiopaedia
Yang N, Septate uterus with ovarian pathologies. Case study, Radiopaedia.org (Accessed on 14 Apr 2024) https://doi.org/10.53347/rID-6978 • CC by-nc-sa 3.0 (modified)
The clinical
relevance of anatomical variants!. The distal third of the two hemivaginas (arrows) separated by a band of fibrous tissue (arrowhead); the obstructed right hemivagina is already dilated, containing heterogeneous debris, which indicates distal obstruction.
www.eurorad.org • CC by-nc-sa-4.0
Accessory and
cavitated uterine mass (ACUM)- A rare Mullerian anomaly. STIR axial image showing thick-walled lesion contiguous with the left lateral uterine wall.
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Accessory and
cavitated uterine mass (ACUM)- A rare Mullerian anomaly. T1 fat suppressed axial image shows bright signal in the central part of the lesion consistent with signal intensity of blood degradation products.
www.eurorad.org • CC by-nc-sa-4.0
Uterine
duplication anomalies • Septate uterus with ovarian pathologies - Ganzer Fall bei Radiopaedia
Yang N, Septate uterus with ovarian pathologies. Case study, Radiopaedia.org (Accessed on 28 Dec 2022) https://doi.org/10.53347/rID-6978 • CC by-nc-sa 3.0 (modified)
Uterine
duplication anomalies • Bicornuate uterus with triamniotic dichorionic triplet pregnancy (3D ultrasound) - Ganzer Fall bei Radiopaedia
Fares G, Bicornuate uterus with triamniotic dichorionic triplet pregnancy (3D ultrasound). Case study, Radiopaedia.org (Accessed on 28 Dec 2022) https://doi.org/10.53347/rID-97799 • CC by-nc-sa 3.0 (modified)
Uterus
subseptus in der Computertomographie links axial und rechts in der Ebene des Uterus rekonstruiert. Zusätzlich zystischer Tumor mit abgebildet.
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The clinical
relevance of anatomical variants!. Sagittal transabdominal US image shows an elliptical echogenic mass, which represents the vaginal cavity markedly distended with blood products (haematocolpos). The uterus extends from the superior aspect of the mass.
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The clinical
relevance of anatomical variants!. Transverse transabdominal US image shows uterus didelphys, with two uterine horns and two separated endometrial cavities.
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The clinical
relevance of anatomical variants!. MR image shows a dilated hemivagina whose content has signal characteristics of blood, forming a blind-ending pouch secondary to obstruction.
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The clinical
relevance of anatomical variants!. A large haematocolpos centrally (arrow), a finding that corresponds to the obstructed right hemivagina. Mild dilatation of the right endometrial cavity and a nondistended left endometrial cavity are also seen.
www.eurorad.org • CC by-nc-sa-4.0
The clinical
relevance of anatomical variants!. Coronal T2-weighted image of a uterus didelphys, obtained in plane with the uterus, shows two widely divergent uterine horns (arrows) separated by a deep fundal cleft.
www.eurorad.org • CC by-nc-sa-4.0
The clinical
relevance of anatomical variants!. Coronal fast spin-echo T2-WI shows a solitary left kidney, confirming renal agenesis with bowel loops in the right renal fossa, which is ipsilateral to the obstructed hemivagina.
www.eurorad.org • CC by-nc-sa-4.0
The clinical
relevance of anatomical variants!. Transverse oblique T2-WI obtained with fat suppression demonstrate communication of the right uterine horn (curved arrow) with the dilated left hemivagina (arrow); the appearance of the left uterine horn is normal.
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Müllerian duct anomalies (MDAs) are congenital abnormalities that occur when the Müllerian ducts (paramesonephric ducts) do not develop correctly. This may be as a result of complete agenesis, defective vertical or lateral fusion, or resorption failure.

Epidemiology

MDAs are estimated to occur in 1-5% of all women. There is a higher rate of women with repeated miscarriages (3-15%) .

Clinical presentation

Despite these anomalies being common , the majority are asymptomatic. Obstruction of the Müllerian duct may occur, and patients present with an abdominal mass and dysmenorrhea. Delayed treatment may result in severe consequences and potentially infertility. Patients may also present with recurrent miscarriages and infertility .

Pathology

Subtypes

The Müllerian duct anomaly classification system divides them according to clinical manifestations, prognosis, and treatment. Accurate diagnosis is essential since management varies according to the type of malformation.

Associations

Renal anomalies are frequently associated, most commonly renal agenesis but also crossed fused renal ectopia, and duplex kidney .

Radiographic features 

Ultrasound
  • should be performed initially
  • confirms any structural abnormalities of the genital tract
  • sometimes cannot help to identify the type of MDA (especially on 2D imaging alone)
  • 3D coronal transvaginal imaging has a high degree of diagnostic accuracy and ideally should be performed in the secretory phase of the menstrual cycle
MRI
  • valuable noninvasive technique
  • evaluation of the female pelvic anatomy
  • accurate MDA classification

Treatment and prognosis

Many patients are asymptomatic and require no treatment. However, where obstruction occurs, surgical intervention is usually required and may result in permanent infertility - counseling is required.

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Fehlbildungen der Gebärmutter:
Uterus
 
Wikipedia • Public domain
Uterus
didelphys
Wikipedia • CC BY-SA 4.0
Uterus
arcuatus
Wikipedia • CC BY-SA 4.0
Uterus
bicornis
Wikipedia • CC BY-SA 4.0
Uterus septus
 
Wikipedia • CC BY-SA 3.0
obstruierte
Hemivagina und ipsilaterale renale Anomalie (OHVIRA) Syndrom
www.eurorad.org • CC by-nc-sa-4.0
Duplikatur
des Uterus
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