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Review
. 2013 Jul-Aug;20(4):533-6.
doi: 10.1016/j.jmig.2013.01.012. Epub 2013 Mar 25.

Is magnetic resonance imaging sufficient to diagnose rudimentary uterine horn? A case report and review of the literature

Kate Devine  1 , Tara McCluskey, Melinda Henne, Alicia Armstrong, Aradhana M Venkatesan, Alan Decherney
Affiliations
Review

Is magnetic resonance imaging sufficient to diagnose rudimentary uterine horn? A case report and review of the literature

Kate Devine et al. J Minim Invasive Gynecol. 2013 Jul-Aug.

Abstract

Imaging is often part of the evaluation of gynecologic disorders, with transvaginal ultrasound being the most frequently used imaging modality. Although laparoscopy, hysterosalpingography, and hysteroscopy can add diagnostic accuracy, they are invasive and costly. Magnetic resonance imaging (MRI) has been increasingly used because it is both noninvasive and highly accurate. Although MRI is more expensive than ultrasound, it is less so than surgery. Given the demonstrated accuracy of MRI in assessing müllerian anomalies, additional imaging is not often sought once an MRI diagnosis is made. However, when imaging findings are not pathognomonic via MRI or otherwise, inaccurate diagnoses and their consequences may occur. We describe the case of a 21-year-old woman with unilateral dysmenorrhea whose MRI features suggested a unicornuate uterus with a hematometrous noncommunicating horn although laparoscopy ultimately revealed a necrotic myoma without an accompanying müllerian anomaly.

Keywords: Laparoscopy; Leiomyoma; Magnetic resonance imaging; Myomectomy; Müllerian anomaly; Unicornuate uterus.

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Figures

Figure 1
Figure 1
(A) Axial T1-weighted axial image of the pelvis and (B) axial T2-weighted image with fat suppression suggest two separate uterine cavities (arrows) with thick intervening myometrium (arrowheads). The T1 hyperintense, T2 intermediate signal of the presumptive left cavity are notably atypical of leiomyoma and suggest necrosis and/or hemorrhage. (C) Sagittal T2-weighted image with fat suppression suggests continuation of right uterine cavity to cervix (arrow) (not shown: left “cavity” does not communicate with right cavity or cervix). (D) Coronal inversion recovery images suggest two separate cavities with only right cavity continuous with the endocervix (arrow).
Figure 2
Figure 2
Figure 2A: Bulbous contour of left anterior corpus, containing involuting intramural leiomyoma. Figure 2B: Restoration of normal uterine contour following laparoscopic resection of degrading myoma and repair of defect.
See this image and copyright information in PMC

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