Uterus Didelphys

This patient presented for further investigation of an abnormality discovered on obstetric ultrasound. Axial and coronal T2-weighted fat-saturated MR images (click image for arrows) demonstrate a duplicated uterus with two separate cervices (red arrows) and uterine horns (green arrows). There is a pregnancy within the right horn (axial HASTE image). The uterus is completely divided with no communication between endometrial cavities, making this a uterus didelphys. There was a longitudinal vaginal septum present (not shown).
Uterus didelphys is a Mullerian fusion anomaly. There is complete duplication of uterine horns and cervices, with no communication between them. There is a vaginal septum in 75% of cases. There is an increased incidence of foetal loss, with a spontaneous abortion rate of 40% and a premature birth rate of 40%.
Uterus didelphys should be differentiated from bicornuate uterus (separation of horns only) and septate uterus (midline uterine septum).
Reference: www.STATdx.com, Amirsys
Credit: Dr Laughlin Dawes
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