Detection of abnormalities of uterus by ultrasound

• Evaluation of congenital abnormalities of the uterus

• Various appearances of kochs / infective pathologies of the uterus on ultrasound

• Myometrial pathologies on ultrasound- Myomas/Adenomyosis

• Intra cavitary lesions of the uterus

UTERINE ANAMOLIES: 3D WITH ITS EASE AND ACCURACY MAY BE THE GOLD
STANDARD FOR THE DIAGNOSIS

External contour – uniformly convex or with

indentation <10mm

Fundal contour- straight or convex

NORMAL

ASRM guidelines -two basic rules to visualize coronal plane of 3D uterus :

Step 1:
Look at the fundal serosa for indentation and measure it

Step2:
Look at the endo-myometrial border ,look for indentation and measure it
This way most anomalies will be detected
 An arcuate uterus: a subtle concave fundal indentation

Diagnosed on coronal section

External fundal contour is flat or convex

Distance
between line
touching the tips
of endometrial
cavities <10mm

Angle
between the
cavities is >90
degrees
 Unicornuate uterus- self explanatory on 3D

Single well formed uterine cavity with single interstitial portion of fallopian tube and
concave fundal contour
Unicornuate Uterus with Rudimentary Horn

Hematometra in
Noncommunicating Horn
Subseptate uterus- septum does not extend to the cervix

External fundal contour is

uniformly convex or with
indentation <10mm

Septum with
central point
at an acute
angle <90
degree

PARTIAL SUBSEPTATE
A septate uterus- extension to the cervix

External fundal contour is

uniformly convex or with
indentation <10mm

Septum from
fundus to
cervix
A bicornuate uterus: external contour indented >10mm

2 well formed uterine

cornua

Fundal
indentation
dividing the
two cornua
 To differentiate between a bicornuate and septate uterus

3.Measure distance from apex of the

fundal external contour to this
straight line between the Tubal ostia
2.A straight line is drawn
1.Look at the external contour between the Tubal ostia

4.The distance from this line and the

deepest point between endometrial
cavities is next measured .
Classification criteria for Ultrasound differentiation of septate from bicornuate  uteri:

* A When apex (3) of the fundal external contour occurs below a straight line between the Tubal ostia (1, 2) or,
  * B  5 mm (arrow) above it, the uterus is bicornuate.

* C  When apex is more than 5 mm (arrow) above the line, uterus is septate.
  
Radiology 2004; 233:19–34

>5mm

>10mm

<=5mm
Uterus didelphys- two distinct cavities and corpora
+- 2 cervixes

2 horns show symmetrical or

asymmetrical development
MRI in imaging Mullerian Abnormalities

evaluation for the presence or absence of the vagina,

cervix, or uterus and also depicts any associated renal
anomalies

shows the level of obstruction of antegrade menstrual fiow

in women with functioning endometrium

depict findings of retrograde menstruation such as

hematosalpinx or endometriosis

Advised in diagnosis of complex mullerian abnormalities