Question:

Which of the studies below can be utilized to investigate a mullerian duct abnormality?
1. Multiplanar T2 and T1 MRI of the pelvis.
2. Transabdominal ultrasound.
3. Multiplanar non-fat saturated FSW T2 sequence MRI of the pelvis.
4. Pelvic exam under anesthesia.
5. All of the above.





Answer:

The correct answer for the question "Which of the studies below can be utilized to investigate a mullerian duct abnormality?" is:



Explanation
Multiplanar T2 and T1 MRI of the pelvis is used for further evaluation after ultrasound or CT of leiomyomas, congenital uterine anomalies, and female pelvic malignancies (e.g., adnexal masses). [An MRI of the pelvis utilizing multiplanar T2 and T1 sequences demonstrated two widely divergent separate uteri and cervices with the uterine volume of the right horn smaller than the left.]

Transabdominal ultrasound is used to investigate for an uterine or renal abnormalities.  [Transabdominal ultrasound demonstrated widely divergent uterine corpi, raising the index of suspicion for uterine duplication anomaly…Renal evaluation revealed an absent left kidney corroborating the diagnosis of uterine duplication anomaly, most likely uterine didelphys. ]

Multiplanar non-fat saturated FSW T2 sequence MRI of the pelvis used to further assess the patency of the uterine segments. [Two days later, an additional MRI of the pelvis was performed utilizing multiplanar non-fat saturated FSE T2 sequences after administration of sterile saline plus sterile ultrasound gel into the vaginal fornix via a small sterile catheter to further assess the patency of the uterine segments and correlate with a physical exam performed by the surgeon.]

Pelvic exam under anesthesia is used to further clinically correlate to the abnormalities seen on MRI and ultrasound. [After the initial MRI, the patient had a physical exam under sedation demonstrating a single cervical opening tilting in the direction of the expected right uterine horn.]



From the manuscript:
Uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: Common presentation of an unusual variation
Radiology Case. 2011 Jan; 5(1):1-8


This article belongs to the OB/GYN section.




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From the manuscript

Uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: Common presentation of an unusual variation

Free full text article: Uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: Common presentation of an unusual variation

Abstract
Mullerian duct abnormalities are congenital malformations that are easily missed and can lead to incorrect diagnosis and unnecessary operative procedures. In this case, a young female presented with cyclic pelvic pain that continued after previous surgical resection of an ovarian cyst. Further investigation with clinical examinations and multimodality imaging demonstrated ipsilateral renal agenesis and a Class III Mullerian duct anomaly (MDA) requiring a second operative procedure. It is believed that this case is a variant of the described obstructed hemi-vagina with ipsilateral renal agenesis (OVIRA) anomaly as pathologically there was ipsilateral renal agenesis and complete vaginal agenesis in our case. It is imperative to have a high clinical suspicion of mullerian duct abnormalities when encountering a patient with other urogenital anomalies. This will decrease the amount of misdiagnoses, guide appropriate surgical intervention, and decrease the risk of future reproductive complications.






References



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10. Zurawin RK, Dietrich JE, Heard MD, Edwards CL. Didelphic Uterus and Obstructed Hemivagina with Renal Agenesis: Case Report and Review of the Literature. Journal of Pediatric Adolescent Gynecology 2004; 17: 137-141.
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