Question:

Patients with a Class III Mullerian duct anomaly such as uterus didephys:
1. Are known to have a low rate of obstretric complications.
2. Usually have had exposure to diethylstilbestrol (DES) in utero.
3. Always present with a vaginal septum.
4. Become symptomatic prior to their first menses.
5. Can present with a hematometrocolpos which can be mistaken for a ruptured ovarian cyst





Answer:

The correct answer for the question "Patients with a Class III Mullerian duct anomaly such as uterus didephys:" is:

5. Can present with a hematometrocolpos which can be mistaken for a ruptured ovarian cyst



Explanation
Patients with didelphys uterus are known to have an increased risk for an unfavorable obstetric outcome. [Additionally, as high as 40% of women with this anomaly are at an increased risk for unfavorable obstetric outcome, but most but have been able to harbor successful pregnancies.]

Class III anomalies have not been linked to exposure of DES. [Class VII anomalies result from exposure to diethylstilbestrol (DES) in utero.]

Patients with Class III anomaly have a complete or partial vaginal septum in 75% of cases. [. While a complete or partial vaginal septum is associated with this anomaly in 75% of cases there was no vaginal septum in this report. ]

Patients usually become symptomatic after menstruation has begun and there is retrograde flow causing cyclical pelvic pain. [Almost uniformly this presentation occurs at menarche when the hemiuterus or hemivagina becomes symptomatic and the patient experiences cyclical dysmenorrhea.]

A common complication of uterus didelphys with a blind uterine horn is hematometrocolpos. Intraoperatively this can look similar to a ruptured ovarian cyst and careful examination needs to be undertaken along with a high suspicion. [Intraoperatively a didelphys uterus with hematometrocolpos may be mistaken for a ruptured ovarian cyst if a thorough evaluation is not performed.]



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.




Bookmark and Share

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



1. Troiano RN, McCarthy SM. Müllerian duct anomalies: imaging and clinical issues. Radiology 2004; 233 (1)1:19-34.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


2. Beatriz LP, Junqueira BP, Allen LM, Spitzer RF, Lucco KL, Babyn PS, Doria AS. Müllerian Duct Anomalies and Mimics in Children and Adolescents: Correlative Intraoperative Assessment with Clinical Imaging. Radiographics 2009; 29: 1085-1103.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


3. Rock JA, Breech LL. Surgery for anomalies of mullerian ducts. In: Rock JA, Jones HW III, eds.TeLinde`s operative gynecology 9th ed
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


4. Gray SW, Skandalakis JE, Broecker BH. Female reproductive system. In: Skandalakis JE, Gray SW,eds Embryology for surgeons
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


5. Li S, Qayyum A, Coakley FV, Hricak H. Association of renal agenesis and mullerian duct anomalies. Journal of Computed Assisted Tomography 2000; 24 (6): 829-834.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


6. Orazi F, Lucchetti C, Schingo P, Marchetti P, Ferro F. Herlyn-Werner-Wunderlich syndrome: uterus didelphys, blind hemivagina and ipsilateral renal agenesis. Sonographic and MR findings in 11 cases Pediatric Radiology
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine
7. Wein: Campbell-Walsh Urology, 9th edition. Chapter 106: Normal Development of the Urogenital System.
Find similar topics on Find similar articles on Google scholarGoogle scholar :: Search for similar topics with the Radiology specific search engine Radiology search engine
Back Back



8. Albert A, Paciuc J. Successful pregnancy following surgery in the obstructed uterus in a uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: Case report and literature review. Journal of Pediatric Adolescent Gynecology 2009; 22 (5): 159-162.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


9. Nahum, G. Uterine anomalies. How common are they, and what is there distribution among subtypes? Journal of Reproductive Medicine 1998 October; 43 (10): 877-887
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


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.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine




Search for articles with similar topics:

Keyword search:

1. didelphys

2. uterine

3. unilateral

4. vaginal agenesis

5. ipsilateral renal agenesis


This article belongs to the OB/GYN section.


Search for more in the Internet

Peer-reviewed Radiology Search




Discuss it!

Bookmark and Share




© Journal of Radiology Case Reports - The Interactive Radiology Journal
Affiliated journal of Radiolopolis - The International Radiology Community


The Journal of Radiology Case Reports