Congenital Uterine Anomalies SONO 123

Unicornuate uterus

agenesis or hypoplasia of one mullerian duct, 20% of uterine anomalies, associated with renal anomalies in 40% of patients, usually ipsolateral to hypoplastic horn, cigar shaped uterus, concave fundal contour with single well formed uterine cavity with single interstitial portion of fallopian tube, fundal indentation greater than 10 mm

Hematocolpos clinical findings

amenorrhea, vague abdominal pain

Hydrometrocolpos sonographic findings

anechoic fluid filled vagina with distended uterus, large cystic pelvic abdominal mass

Which uterine anomaly has a fairly normal shaped uterus with a slight indentation on the superior aspect of the endometrial cavity and can be very difficult to detect by ultrasound?

arcuate

Uterine Aplasia

arrested developlemt of Mullerian ducts, uterus does not fully develop instead two tubes are present, reproductive sterility, associated with renal agenesis

What is a uterus with two separate uterine cavities and one cervix?

bicornuate

Hematocolpos

blood filled dilated vagina but without any accompanying blood (often menstrual blood) within the uterine cavity

Hematometrocolpos

blood filled distended uterus and vagina, estimated incidence in teenagers is at 1 in 1000-2000

Hydrometra clinical findings

bulging hymen, abdominal pain, abdominal mass

Hematometra etiologies

congenital cervical stenosis, complications of surgical treatment, mullerian duct anomaly

Hydrometra etiologies

endometrial carcinoma, astresia or stenosis, more common in patients with renal anomalies

A young girl is being seen for an early onset on menses, sonographicly you may see?

enlarged uterus and follicles on ovaries

Hydrocolpos

expanded fluid filled vaginal cavity

Hydrometrocolpos

expanded fluid filled vaginal cavity with associated distention of the uterine cavity

Hematometrocolpos population

females often teenagers at onset of menarche, patients iwth mullarien duct anomalies

Hydrocolpos population

females, may present in infancy or be delayed until menarche

Hydrocolpos sonographic findings

fluid filled vaginal canal, anechoic mass between bladder and rectum

Characteristics of a septated uterus include?

found high in the fundus, formed by a small septation, frequently associated with infertility, can be surgically repaired

Uterus originates

from paired Mullerian ducts, septum forms between fused ducts but reabsorbs into single uterine cavity.

Uterine morphology of normal uterus

fundus is straight or convex and external contour is convex or straight with indentation less than 10mm

What is the best indication to suspect Pyometra?

gas is present

A 14 year old female presents with a history of primary amenorrhea, monthly lower abdominal pains and a palpable mass in the lower abdomen. What does she most likely present with?

hematometrocolpos

Hydrocolpos differentials

hematometrocolpos, pelvic abscess

Hematocolpos etiologies

imperforate hymen, transverse vaginal septum, mullerian duct anomaly

Hematometrocolpos etiologies

imperforated hymen (most common 2/3rds cases), transverse vaginal septum, vaginal stenosis, vaginal atresia

Hydrometrocolpos etiologies

imperforated hymen (most common), vaginal stenosis, cervical stenosis

Hydrocolpos etiologies

imperforated hymen, vaginal stenosis, transverse vaginal septum

Hydrometrocolpos clinical findings

infancy may present as lower abdominal mass

Pyometra

infection of the endometrial cavity with resulting expansion due to accumulated pus

what organ should also be scanned if a patient is suspected to have uterine duplication anomalies?

kidneys

Suspected uterine duplication anomalies should have

kidneys scanned as there is a high association of renal agenesis

Pyometria sonographic findings

large endometrial cavity fluid collection centrally cystic, round, moderately enlarged uterus containing echogenic material

Hydrometrocolpos population

may present at infancy or delayed till menarche

Arcuate uterus

near complete resorption of uterovaginal septum leaves mild concave indentation of endometrial cavity at fundus, not clear if a true anomaly or anatomic variant, very difficult to detect on US, fundus has concave fundal indentation with central point at obtuse angle greater than 90 degrees, uterus is convex with indentation less than 10mm

Didelphys Uterus

non-obstructed failure of lateral fusion involving both uterus and vagina resulting in formation of double uterus, double cervix, double vagina at 45 degree angle to each other, one of least common anomalies 5-7% mullerian defects, fetal survival rate 54%, highest association with vaginal septa

Which of the following describes a decreased frequency of periods, with more than 35 day between periods and only 4-9 periods a year?

oligomenorrhea

Hematometra population

post puberty females

In which phase does the endometrium demonstrates the "triple-line" sign?

proliferative phase

Pyometra is?

pus in uterine cavity

Hematometra clinical findings

recurrent pelvic pain with pelvic mass (cyclic)

During which of the phases is the endometrium at its greatest thickness and echogenicity?

secretory phase

What congenital uterine anomaly is most associated with infertility?

septated uterus

Hematocolpos sonographic findings

show anechoic mass along extent of vagina not involving uterus

Bicornuate and septate uteruses are not easily differentiated from one another by ultrasound. Which of the following are true of the bicornuate uterus?

there are two uterine bodies

Diethylstilbestrol DES

used 1945-1971 to prevent miscarriage, estrogen analogue, uterine anomalies common in women exposed to DES inutero 69%, most common T shaped uterus (70%) also have doubled risk of spontaneous abortion and nine-fold increased risk of ectopic pregnancy

Hematometrocolpos differentials

uterus didelphys

Hematometra

uterus fills with menstrual blood, treated surgically with hymenotomy

How many mullerian ducts does the uterus originate from?

2

Uterine anomalies occur in fertile women with normal reproductive outcomes. Approximately what percentage of congenital uterine anomalies occur in females?

5%

the uterus in a 28 year old woman. She's experienced 3 months of amenorrhea. This image presents two uterine cavities, gestational sac, and one cervix, what best describes this image?the uterus in a 28 year old woman. She's experienced 3 months of amenorrhea. This image presents two uterine cavities, gestational sac, and one cervix, what best describes this image?

Gravid Bicornuate Uterus

Hydrocolpos clinical findings

Infancy may present as lower abdominal mass

What triggers the secretion of FSHRF & LHRF from the hypothalamus?

Low estrogen levels during the first few days of the menstrual cycle

Pain that is experienced midway through the menstrual cycle is known as

Mittleschmertz

Hydrometrocolpos differentials

abscess, associated with imperforate anus, uterus didelphys, renal agenesis

Why should the kidneys be scanned with association to uterine duplication anomalies?

absence of kidney, failed development of the renal

Septate Uterus

absent or incomplete resorption of intervening uterovaginal septum, most common congenital anomaly of uterus 55% of all anomalies, small septation creates two partially separated uterine cavities usually high in fundus. Fundus typically convex but may be flat or slightly concave, indentation less than 10 mm treated by transvaginal hysteroscopic resection of septum, poorest reproductive outcomes 65% miscarriage rate, fetal survival rate 32%

Hematometra sonographic findings

cystic mass in lower mid-abdomen with fine diffuse internal echoes, anechoic to hypoechoic uterus

Bicornuate Uterus

demonstrates two completely separate uterine cavities and one cervix, represents 10% Mullerian duct anomalies, uterus described as heart shaped, two well formed cornu, fundal indentation is greater than 10mm, if surgical abdominal approach metroplasty performed, fetal survival rate 60%

A complete duplication of the uterus, cervix, and vagina is called a:

didelphys uterus

Hydrometra

distended uterus filled with clear non infected fluid

Pyometra etiologies

endometritis, PID, uterien malignancies, retained products of conception

Hematometrocolpos sonographic findings

may show distended midline tubular structure between bladder and rectum, internal echo texture variable often low level echoes seen

Hematocolpos population

most often in premenarchal females

Is hydrocolpos a normal collection of fluid in the vagina?

no it is not normal