Pediatric Mullerian Duct Anomalies

  • Etiology: Mullerian ducts are precursors of fallopian tubes, uterus, cervix and upper 2/3 of vagina
  • Imaging: Types:
    — Hypoplasia or agenesis of vagina, cervix, uterine fundus, fallopian tubes
    — Didelphys – separate uterus and cervix and vagina
    — Bicornuate – separate uterus and cervix with common vagina or separate uterus with common cervix and vagina
    — Septate – separate uterus and cervix with common vagina or separate uterus with common cervix and vagina
    — Arcuate
  • Note: Look for associated renal anomalies
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Mullerian duct anomalies in 5-6% of general population and higher in infertility patients
    — High association with infertility, endometriosis, miscarriage
    — Most common anomaly is a septate uterus
    — Commonly associated with renal anomalies – renal agenesis, ectopia, hypoplasia, fusion, malrotation, duplication
    — Other associated congenital anomalies – vertebral bodies, cardiac, syndromes – Klippel-Feil syndrome

Radiology Cases of Mullerian Duct Anomalies

Radiology Cases of Mullerian Duct Anomalies in the Form of Right Unicornuate Uterus

MRI of unicornuate uterus
Sequential coronal T2 MRI without contrast images of the pelvis show the uterus to consist of a single fluid filled dilated right horn (above) which empties into the vagina (below).

Radiology Cases of Mullerian Duct Anomalies in the Form of Bicornuate Unicollis Uterus With Left Horn Intact and Atretic and Dilated Right Horn and Right Hydrohematosalpinx

MRI of Mullerian duct anomaly of a bicornuate unicollis uterus with the left horn intact and with an atretic and dilated right horn and right hydrohematosalpinx
Contiguous axial (above) and coronal (below) T2 MRI of the pelvis show a bicornuate unicollis uterus with the left horn intact and with the right horn atretic and dilated and associated with a right hydrohematosalpinx.

Radiology Cases of Mullerian Duct Anomalies in the Form of Uterus Didelphys or Bicornuate Uterus

CT of uterus didelphys or bicornuate uterus
Sequential axial CT with contrast of the abdomen shows a fluid-filled bladder in the anterior aspect of the pelvis that has a soft tissue structure posterior to it, believed to be the uterus, that is composed of what appear to be left and right horns.