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Gynecology
Diagnosis
Uterus
Congenital
DES Exposure
DES Exposure
Akram M. Shaaban, MBBCh
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Class VII müllerian duct anomaly (MDA) based on American Society for Reproductive Medicine (ASRM) classification
              • Has been classically associated with in utero exposure of diethylstilbestrol (DES)
              • Similar spectrum of morphologic changes reported without history of DES exposure

            IMAGING

            • General Features

              • Hysterosalpingography

                • MR Findings

                  • Ultrasonographic Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          CLINICAL ISSUES

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                Selected References

                                1. Sood A et al: T-shaped uterus in the 21st century (post DES era) - we need to know more! J Hum Reprod Sci. 12(4):283-6, 2019
                                2. Behr SC et al: Imaging of müllerian duct anomalies. Radiographics. 32(6):E233-50, 2012
                                3. Marcal L et al: Mullerian duct anomalies: MR imaging. Abdom Imaging. 36(6):756-64, 2011
                                4. Bermejo C et al: Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 35(5):593-601, 2010
                                5. Chandler TM et al: Mullerian duct anomalies: from diagnosis to intervention. Br J Radiol. 82(984):1034-42, 2009
                                6. Olpin JD et al: Imaging of Müllerian duct anomalies. Clin Obstet Gynecol. 52(1):40-56, 2009
                                7. Steinkeler JA et al: Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 29(5):1353-70, 2009
                                8. Deutch TD et al: The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of müllerian duct anomalies: a review of the literature. J Ultrasound Med. 27(3):413-23, 2008
                                9. Troiano RN et al: Mullerian duct anomalies: imaging and clinical issues. Radiology. 233(1):19-34, 2004
                                10. Imaoka I et al: MR imaging of disorders associated with female infertility: use in diagnosis, treatment, and management. Radiographics. 23(6):1401-21, 2003
                                11. Kruse K et al: Clinical implications of DES. Nurse Pract. 28(7 Pt 1):26-32,35, table of contents; quiz 35-7, 2003
                                12. Troiano RN: Magnetic resonance imaging of mullerian duct anomalies of the uterus. Top Magn Reson Imaging. 14(4):269-79, 2003
                                13. Swan SH: Intrauterine exposure to diethylstilbestrol: long-term effects in humans. APMIS. 108(12):793-804, 2000
                                14. Woodward PJ et al: MR imaging in the evaluation of female infertility. Radiographics. 13(2):293-310, 1993
                                15. Milhan D: DES exposure: implications for childbearing. Int J Childbirth Educ. 7(4):21-8, 1992
                                16. Carrington BM et al: Mullerian duct anomalies: MR imaging evaluation. Radiology. 176(3):715-20, 1990
                                17. Kaufman RH et al: Upper genital tract changes and infertility in diethylstilbestrol-exposed women. Am J Obstet Gynecol. 154(6):1312-8, 1986
                                18. Glaze GM: Diethylstilbestrol exposure in utero: review of literature. J Am Osteopath Assoc. 83(6):435-8, 1984
                                19. Nunley WC Jr et al: Upper reproductive tract radiographic findings in DES-exposed female offspring. AJR Am J Roentgenol. 142(2):337-9, 1984
                                20. Stillman RJ et al: Diethylstilbestrol exposure in utero and endometriosis in infertile females. Fertil Steril. 41(3):369-72, 1984
                                21. Haney AF et al: Infertility in women exposed to diethylstilbestrol in utero. J Reprod Med. 28(12):851-6, 1983
                                22. Kaufman RH: Structural changes of the genital tract associated with in utero exposure to diethylstilbestrol. Obstet Gynecol Annu. 11:187-202, 1982
                                23. Kinch RA: Diethylstilbestrol in pregnancy: an update. Can Med Assoc J. 127(9):812-3, 1982
                                24. Ben-Baruch G et al: Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders. Acta Obstet Gynecol Scand. 60(4):395-7, 1981
                                25. Berger MJ et al: Impaired reproductive performance in DES-exposed women. Obstet Gynecol. 55(1):25-7, 1980
                                26. Kaufman RH et al: Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol. Am J Obstet Gynecol. 137(3):299-308, 1980
                                27. Rennell CL: T-shaped uterus in diethylstilbestrol (DES) exposure. AJR Am J Roentgenol. 132(6):979-80, 1979
                                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 VII müllerian duct anomaly (MDA) based on American Society for Reproductive Medicine (ASRM) classification
                                            • Has been classically associated with in utero exposure of diethylstilbestrol (DES)
                                            • Similar spectrum of morphologic changes reported without history of DES exposure

                                          IMAGING

                                          • General Features

                                            • Hysterosalpingography

                                              • MR Findings

                                                • Ultrasonographic Findings

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Staging, Grading, & Classification

                                                        CLINICAL ISSUES

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              Selected References

                                                              1. Sood A et al: T-shaped uterus in the 21st century (post DES era) - we need to know more! J Hum Reprod Sci. 12(4):283-6, 2019
                                                              2. Behr SC et al: Imaging of müllerian duct anomalies. Radiographics. 32(6):E233-50, 2012
                                                              3. Marcal L et al: Mullerian duct anomalies: MR imaging. Abdom Imaging. 36(6):756-64, 2011
                                                              4. Bermejo C et al: Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 35(5):593-601, 2010
                                                              5. Chandler TM et al: Mullerian duct anomalies: from diagnosis to intervention. Br J Radiol. 82(984):1034-42, 2009
                                                              6. Olpin JD et al: Imaging of Müllerian duct anomalies. Clin Obstet Gynecol. 52(1):40-56, 2009
                                                              7. Steinkeler JA et al: Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 29(5):1353-70, 2009
                                                              8. Deutch TD et al: The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of müllerian duct anomalies: a review of the literature. J Ultrasound Med. 27(3):413-23, 2008
                                                              9. Troiano RN et al: Mullerian duct anomalies: imaging and clinical issues. Radiology. 233(1):19-34, 2004
                                                              10. Imaoka I et al: MR imaging of disorders associated with female infertility: use in diagnosis, treatment, and management. Radiographics. 23(6):1401-21, 2003
                                                              11. Kruse K et al: Clinical implications of DES. Nurse Pract. 28(7 Pt 1):26-32,35, table of contents; quiz 35-7, 2003
                                                              12. Troiano RN: Magnetic resonance imaging of mullerian duct anomalies of the uterus. Top Magn Reson Imaging. 14(4):269-79, 2003
                                                              13. Swan SH: Intrauterine exposure to diethylstilbestrol: long-term effects in humans. APMIS. 108(12):793-804, 2000
                                                              14. Woodward PJ et al: MR imaging in the evaluation of female infertility. Radiographics. 13(2):293-310, 1993
                                                              15. Milhan D: DES exposure: implications for childbearing. Int J Childbirth Educ. 7(4):21-8, 1992
                                                              16. Carrington BM et al: Mullerian duct anomalies: MR imaging evaluation. Radiology. 176(3):715-20, 1990
                                                              17. Kaufman RH et al: Upper genital tract changes and infertility in diethylstilbestrol-exposed women. Am J Obstet Gynecol. 154(6):1312-8, 1986
                                                              18. Glaze GM: Diethylstilbestrol exposure in utero: review of literature. J Am Osteopath Assoc. 83(6):435-8, 1984
                                                              19. Nunley WC Jr et al: Upper reproductive tract radiographic findings in DES-exposed female offspring. AJR Am J Roentgenol. 142(2):337-9, 1984
                                                              20. Stillman RJ et al: Diethylstilbestrol exposure in utero and endometriosis in infertile females. Fertil Steril. 41(3):369-72, 1984
                                                              21. Haney AF et al: Infertility in women exposed to diethylstilbestrol in utero. J Reprod Med. 28(12):851-6, 1983
                                                              22. Kaufman RH: Structural changes of the genital tract associated with in utero exposure to diethylstilbestrol. Obstet Gynecol Annu. 11:187-202, 1982
                                                              23. Kinch RA: Diethylstilbestrol in pregnancy: an update. Can Med Assoc J. 127(9):812-3, 1982
                                                              24. Ben-Baruch G et al: Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders. Acta Obstet Gynecol Scand. 60(4):395-7, 1981
                                                              25. Berger MJ et al: Impaired reproductive performance in DES-exposed women. Obstet Gynecol. 55(1):25-7, 1980
                                                              26. Kaufman RH et al: Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol. Am J Obstet Gynecol. 137(3):299-308, 1980
                                                              27. Rennell CL: T-shaped uterus in diethylstilbestrol (DES) exposure. AJR Am J Roentgenol. 132(6):979-80, 1979