Valdez-Sinon Arielle N, Toscano Marika A, Baker Valerie L, Segars James, Kohn Jaden R
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA.
Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2024 Aug 27;16(8):e67967. doi: 10.7759/cureus.67967. eCollection 2024 Aug.
As evidenced by the 2021 American Society for Reproductive Medicine Müllerian Anomaly Classification (ASRM MAC), there are numerous possible configurations of the female genitourinary system. Some anomalies place patients at higher risk of infertility, miscarriage, fetal malpresentation, and preterm labor. Correct characterization of Müllerian anomalies is critical for proper infertility treatment and pregnancy counseling. This case study of a 32-year-old nulliparous woman describes the radiographic modalities utilized in the diagnosis of a complex Müllerian anomaly. To characterize the Müllerian anomaly, the patient underwent a 2D transvaginal ultrasound (TVUS), saline infusion sonohysterogram (SIS) with 3D reconstruction, and second-opinion interpretation of a previous MRI. Radiographic diagnoses were conflicting among different modalities. While the saline infusion sonohysterogram suggested a bicornuate uterus, the MRI of the anomaly was interpreted as a uterine didelphys. Furthermore, TVUS and MRI indicated the presence of two cervices, while only one cervix was appreciated with SIS. Given the inconsistent interpretation of her anomaly, the patient was brought to the operating room. After direct visualization with exam and hysteroscopy, the patient was ultimately diagnosed with a uterine didelphys with a communication of endometrial cavities in the lower uterine segment, two cervices, a hypoplastic right vagina, and a longitudinal vaginal septum extending to the hymen. The patient was counseled that this anomaly is not expected to impact natural conception and would not require surgical resection. The patient went on to conceive spontaneously in the right uterine horn, with a plan for primary cesarean delivery. This case was of sufficient complexity that an accurate diagnosis was not made until physical exam and hysteroscopic visualization verified findings from MRI and ultrasonographic imaging. Appropriately describing a Müllerian anomaly according to the 2021 ASRM MAC is crucial, and multiple forms of imaging and physical examination may be necessary to accurately characterize uterine anomalies.
2021年美国生殖医学学会苗勒管异常分类（ASRM MAC）表明，女性生殖泌尿系统存在多种可能的结构形态。一些异常会使患者面临更高的不孕、流产、胎位异常和早产风险。准确识别苗勒管异常对于恰当的不孕治疗和妊娠咨询至关重要。本病例研究的对象是一名32岁未育女性，描述了用于诊断复杂苗勒管异常的影像学检查方法。为了明确苗勒管异常的情况，患者接受了二维经阴道超声（TVUS）、三维重建的盐水灌注子宫输卵管造影（SIS）以及对之前MRI的二次解读。不同检查方法得出的影像学诊断结果相互矛盾。虽然盐水灌注子宫输卵管造影显示为双角子宫，但该异常的MRI结果被解读为双子宫。此外，TVUS和MRI显示有两个宫颈，而SIS仅显示一个宫颈。鉴于对其异常情况的解读不一致，该患者被送往手术室。经过检查和宫腔镜直视后，患者最终被诊断为双子宫，子宫下段子宫内膜腔相通，有两个宫颈，右侧阴道发育不全，以及延伸至处女膜的阴道纵隔。患者被告知，这种异常预计不会影响自然受孕，也无需手术切除。该患者后来在右子宫角自然受孕，并计划进行初次剖宫产。这个病例非常复杂，直到体格检查和宫腔镜检查证实了MRI和超声成像的结果后，才做出准确诊断。根据2021年ASRM MAC准确描述苗勒管异常至关重要，可能需要多种影像学检查和体格检查才能准确界定子宫异常情况。
