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Bicornuate Uterus
Akram M. Shaaban, MBBCh; Caroline Reinhold, MD, MSc; Khashayar Rafatzand, MD, FRCPC
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Class IV müllerian duct anomaly (MDA)
                • Based on Buttram & Gibbons/American Fertility Society (AFS) classification system
                • Complete (IVa): Fundal cleft extending to internal cervical os
                • Partial (IVb): Fundal cleft variable in length, ending proximal to internal os
              • Incomplete fusion of fundal myometrium with 2 symmetric, communicating uterine horns

            IMAGING

            • General Features

              • Radiographic Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Ludwin A et al: Two- and three-dimensional ultrasonography and sonohysterography versus hysteroscopy with laparoscopy in the differential diagnosis of septate, bicornuate, and arcuate uteri. J Minim Invasive Gynecol. 20(1):90-9, 2013
                                            2. Behr SC et al: Imaging of müllerian duct anomalies. Radiographics. 32(6):E233-50, 2012
                                            3. Ludwin A et al: Diagnostic accuracy of sonohysterography, hysterosalpingography and diagnostic hysteroscopy in diagnosis of arcuate, septate and bicornuate uterus. J Obstet Gynaecol Res. 37(3):178-86, 2011
                                            4. Marcal L et al: Mullerian duct anomalies: MR imaging. Abdom Imaging. 36(6):756-64, 2011
                                            5. Carrascosa PM et al: Virtual hysterosalpingography: a new multidetector CT technique for evaluating the female reproductive system. Radiographics. 30(3):643-61, 2010
                                            6. Junqueira BL et al: Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics. 29(4):1085-103, 2009
                                            7. Steinkeler JA et al: Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 29(5):1353-70, 2009
                                            8. Papp Z et al: Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases. J Reprod Med. 51(7):544-52, 2006
                                            9. Troiano RN et al: Mullerian duct anomalies: imaging and clinical issues. Radiology. 233(1):19-34, 2004
                                            10. Troiano RN: Magnetic resonance imaging of mullerian duct anomalies of the uterus. Top Magn Reson Imaging. 14(4):269-79, 2003
                                            11. Grimbizis GF et al: Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 7(2):161-74, 2001
                                            12. Ascher SM: MR imaging of the female pelvis: the time has come. Radiographics. 18(4):931-45, 1998
                                            13. Wu MH et al: Detection of congenital mullerian duct anomalies using three-dimensional ultrasound. J Clin Ultrasound. 25(9):487-92, 1997
                                            14. Pellerito JS et al: Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 183(3):795-800, 1992
                                            15. Carrington BM et al: Mullerian duct anomalies: MR imaging evaluation. Radiology. 176(3):715-20, 1990
                                            16. Fedele L et al: Magnetic resonance evaluation of double uteri. Obstet Gynecol. 74(6):844-7, 1989
                                            17. Reuter KL et al: Septate versus bicornuate uteri: errors in imaging diagnosis. Radiology. 172(3):749-52, 1989
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Class IV müllerian duct anomaly (MDA)
                                                          • Based on Buttram & Gibbons/American Fertility Society (AFS) classification system
                                                          • Complete (IVa): Fundal cleft extending to internal cervical os
                                                          • Partial (IVb): Fundal cleft variable in length, ending proximal to internal os
                                                        • Incomplete fusion of fundal myometrium with 2 symmetric, communicating uterine horns

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Ludwin A et al: Two- and three-dimensional ultrasonography and sonohysterography versus hysteroscopy with laparoscopy in the differential diagnosis of septate, bicornuate, and arcuate uteri. J Minim Invasive Gynecol. 20(1):90-9, 2013
                                                                                      2. Behr SC et al: Imaging of müllerian duct anomalies. Radiographics. 32(6):E233-50, 2012
                                                                                      3. Ludwin A et al: Diagnostic accuracy of sonohysterography, hysterosalpingography and diagnostic hysteroscopy in diagnosis of arcuate, septate and bicornuate uterus. J Obstet Gynaecol Res. 37(3):178-86, 2011
                                                                                      4. Marcal L et al: Mullerian duct anomalies: MR imaging. Abdom Imaging. 36(6):756-64, 2011
                                                                                      5. Carrascosa PM et al: Virtual hysterosalpingography: a new multidetector CT technique for evaluating the female reproductive system. Radiographics. 30(3):643-61, 2010
                                                                                      6. Junqueira BL et al: Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics. 29(4):1085-103, 2009
                                                                                      7. Steinkeler JA et al: Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 29(5):1353-70, 2009
                                                                                      8. Papp Z et al: Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases. J Reprod Med. 51(7):544-52, 2006
                                                                                      9. Troiano RN et al: Mullerian duct anomalies: imaging and clinical issues. Radiology. 233(1):19-34, 2004
                                                                                      10. Troiano RN: Magnetic resonance imaging of mullerian duct anomalies of the uterus. Top Magn Reson Imaging. 14(4):269-79, 2003
                                                                                      11. Grimbizis GF et al: Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 7(2):161-74, 2001
                                                                                      12. Ascher SM: MR imaging of the female pelvis: the time has come. Radiographics. 18(4):931-45, 1998
                                                                                      13. Wu MH et al: Detection of congenital mullerian duct anomalies using three-dimensional ultrasound. J Clin Ultrasound. 25(9):487-92, 1997
                                                                                      14. Pellerito JS et al: Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 183(3):795-800, 1992
                                                                                      15. Carrington BM et al: Mullerian duct anomalies: MR imaging evaluation. Radiology. 176(3):715-20, 1990
                                                                                      16. Fedele L et al: Magnetic resonance evaluation of double uteri. Obstet Gynecol. 74(6):844-7, 1989
                                                                                      17. Reuter KL et al: Septate versus bicornuate uteri: errors in imaging diagnosis. Radiology. 172(3):749-52, 1989