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Septate Uterus
Akram M. Shaaban, MBBCh; Susan M. Ascher, MD, FISMRM, FSCBT/MR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Class V müllerian duct anomaly based on Buttram & Gibbons classification and American Society for Reproductive Medicine revision
            • Incomplete resorption of uterovaginal septum
              • Complete: Septum extends to external os and may even extend into vagina
              • Partial: Variable length septum ending proximal to external cervical os
            • Class U2 of ESHRE/ESGE consensus on classification of female genital tract congenital anomalies
              • Incorporates all cases with normal fusion and abnormal absorption of midline septum
              • Septate is defined as uterus with normal outline and internal indentation at fundal midline exceeding 50% of uterine wall thickness
              • Class U2 is further divided into 2 subclasses according to degree of uterine corpus deformity
                • Class U2a (or partial septate uterus) characterized by existence of a septum partly dividing uterine cavity above level of internal cervical os
                • Class U2b (or complete septate uterus) characterized by existence of septum fully dividing uterine cavity up to level of internal cervical os

          IMAGING

          • General Features

            • Hysterosalpingography (HSG)

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Bermejo C et al: Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations. Ultrasound Obstet Gynecol. 43(3):336-45, 2014
                                      2. Fedele L et al: Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases. Hum Reprod. 28(6):1580-3, 2013
                                      3. Grimbizis GF et al: The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg. 10(3):199-212, 2013
                                      4. Allen JW et al: Incidence of ovarian maldescent in women with mullerian duct anomalies: evaluation by MRI. AJR Am J Roentgenol. 198(4):W381-5, 2012
                                      5. Behr SC et al: Imaging of müllerian duct anomalies. Radiographics. 32(6):E233-50, 2012
                                      6. Faivre E et al: Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging. J Minim Invasive Gynecol. 19(1):101-6, 2012
                                      7. 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
                                      8. Ghi T et al: Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertil Steril. 92(2):808-13, 2009
                                      9. Mueller GC et al: Müllerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis. AJR Am J Roentgenol. 189(6):1294-302, 2007
                                      10. Takeuchi M et al: Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol. 15(11):2244-55, 2005
                                      11. Patton PE et al: The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum. Am J Obstet Gynecol. 190(6):1669-75; discussion 1675-8, 2004
                                      12. Marten K et al: MRI in the evaluation of mullerian duct anomalies. Clin Imaging. 27(5):346-50, 2003
                                      13. Letterie GS et al: A comparison of pelvic ultrasound and magnetic resonance imaging as diagnostic studies for mullerian tract abnormalities. Int J Fertil Menopausal Stud. 40(1):34-8, 1995
                                      14. Ozsarlak O et al: Septate uterus: hysterosalpingography and magnetic resonance imaging findings. Eur J Radiol. 21(2):122-5, 1995
                                      15. Woodward PJ et al: Congenital uterine malformations. Curr Probl Diagn Radiol. 24(5):178-97, 1995
                                      16. Woodward PJ et al: MR imaging in the evaluation of female infertility. Radiographics. 13(2):293-310, 1993
                                      17. Markham SM et al: Structural anomalies of the reproductive tract. Curr Opin Obstet Gynecol. 4(6):867-73, 1992
                                      18. Buttram VC Jr et al: Mullerian anomalies: a proposed classification. (An analysis of 144 cases). Fertil Steril. 32(1):40-6, 1979
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Definitions

                                                • Class V müllerian duct anomaly based on Buttram & Gibbons classification and American Society for Reproductive Medicine revision
                                                • Incomplete resorption of uterovaginal septum
                                                  • Complete: Septum extends to external os and may even extend into vagina
                                                  • Partial: Variable length septum ending proximal to external cervical os
                                                • Class U2 of ESHRE/ESGE consensus on classification of female genital tract congenital anomalies
                                                  • Incorporates all cases with normal fusion and abnormal absorption of midline septum
                                                  • Septate is defined as uterus with normal outline and internal indentation at fundal midline exceeding 50% of uterine wall thickness
                                                  • Class U2 is further divided into 2 subclasses according to degree of uterine corpus deformity
                                                    • Class U2a (or partial septate uterus) characterized by existence of a septum partly dividing uterine cavity above level of internal cervical os
                                                    • Class U2b (or complete septate uterus) characterized by existence of septum fully dividing uterine cavity up to level of internal cervical os

                                              IMAGING

                                              • General Features

                                                • Hysterosalpingography (HSG)

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              • Microscopic Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Bermejo C et al: Three-dimensional ultrasound and magnetic resonance imaging assessment of cervix and vagina in women with uterine malformations. Ultrasound Obstet Gynecol. 43(3):336-45, 2014
                                                                          2. Fedele L et al: Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases. Hum Reprod. 28(6):1580-3, 2013
                                                                          3. Grimbizis GF et al: The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg. 10(3):199-212, 2013
                                                                          4. Allen JW et al: Incidence of ovarian maldescent in women with mullerian duct anomalies: evaluation by MRI. AJR Am J Roentgenol. 198(4):W381-5, 2012
                                                                          5. Behr SC et al: Imaging of müllerian duct anomalies. Radiographics. 32(6):E233-50, 2012
                                                                          6. Faivre E et al: Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging. J Minim Invasive Gynecol. 19(1):101-6, 2012
                                                                          7. 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
                                                                          8. Ghi T et al: Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertil Steril. 92(2):808-13, 2009
                                                                          9. Mueller GC et al: Müllerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis. AJR Am J Roentgenol. 189(6):1294-302, 2007
                                                                          10. Takeuchi M et al: Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol. 15(11):2244-55, 2005
                                                                          11. Patton PE et al: The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum. Am J Obstet Gynecol. 190(6):1669-75; discussion 1675-8, 2004
                                                                          12. Marten K et al: MRI in the evaluation of mullerian duct anomalies. Clin Imaging. 27(5):346-50, 2003
                                                                          13. Letterie GS et al: A comparison of pelvic ultrasound and magnetic resonance imaging as diagnostic studies for mullerian tract abnormalities. Int J Fertil Menopausal Stud. 40(1):34-8, 1995
                                                                          14. Ozsarlak O et al: Septate uterus: hysterosalpingography and magnetic resonance imaging findings. Eur J Radiol. 21(2):122-5, 1995
                                                                          15. Woodward PJ et al: Congenital uterine malformations. Curr Probl Diagn Radiol. 24(5):178-97, 1995
                                                                          16. Woodward PJ et al: MR imaging in the evaluation of female infertility. Radiographics. 13(2):293-310, 1993
                                                                          17. Markham SM et al: Structural anomalies of the reproductive tract. Curr Opin Obstet Gynecol. 4(6):867-73, 1992
                                                                          18. Buttram VC Jr et al: Mullerian anomalies: a proposed classification. (An analysis of 144 cases). Fertil Steril. 32(1):40-6, 1979