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Unicornuate with Rudimentary Horn

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Our next case is a patient who's

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34 years old with imaging of the pelvis

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using a female pelvis MRI protocol.

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This is our large field of view,

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T2, without fat saturation.

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We focus on the T2-weighted images for

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female pelvis imaging because it shows you

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nicely the distinction between the different

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tissues, particularly of the uterus.

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So that's where we do a lot of our

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attention on that particular area.

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So this is the large field of view.

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T2.

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And that's important because we can

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see an ovary here on the left and

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then we see our right ovary over here.

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We have two normal-appearing bilateral ovaries.

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As we come down a little bit lower,

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we see this structure right next to the left

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ovary, and then you see a uterus right here.

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So let's get into our smaller field

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of view, T2, and get a little bit more

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detail about what's going on there.

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We can see bits of the ovaries again right

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there, but we're not that concerned about it.

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We're concerned about what this structure is,

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as well as this structure.

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So you can see here we

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have a single uterine horn.

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It's deviated to the right and maybe it's a

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little bit smaller than you would normally see.

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The length looks pretty normal but the width

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is certainly skinnier than you'd expect.

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It then does look like it connects

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to this structure right here.

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You have vessels down here that somewhat

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look like they connect right here.

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So what this is, it's not an ovarian mass.

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What this is, is a unicornuate uterus,

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which is right here, with a rudimentary horn.

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Now what's important when you're

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looking at these, is to tell,

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number one, is there a rudimentary horn?

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And number two, does it have endometrium?

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So in this case, that's

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again why you want your T2s.

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Your endometrium is going to be very bright

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on your T2 weighted imaging, as it is here.

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And we're going to look closely in

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here, and we can see some T2 bright

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signal within that rudimentary horn.

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Here's a fat saturated version right here.

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And again, your uterus looks pretty normal.

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That right horn, this person

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actually had a C-section scar right there.

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So this was already a known diagnosis.

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And your rudimentary horn is over

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here and it has T2 bright in it.

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So this has endometrium.

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This patient as well, we looked up at

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her kidneys and they both looked normal.

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They were present in normal

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positions with no anomalies there.

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Usually if you're going to have a

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uterine anomaly, it's going to be on

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the same side as the rudimentary horn.

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So if we To see anything, it would

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be on the left side because the

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left side is the rudimentary horn.

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So in these particular patients, it's

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absolutely vital to tell if there's that

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rudimentary horn and if it has endometrium.

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And that is because they're at risk

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of ectopic if they have a rudimentary

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horn because they have endometrium.

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If they do not have any endometrium,

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there's no place for an ectopic

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really to get in there and to implant.

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So you're not going to have that risk.

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You can leave it in place and it's fine.

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But if they have it, it needs

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to be surgically removed.

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They can also, if this is a non-communicating

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rudimentary horn, no communication to

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that other, more normal-appearing right

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sided horn, you can have retained blood in

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there, which can be painful, can increase

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your risk of miscarriage in the other

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horn, whether it's communicating or not,

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because it acts on this inflammatory type

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process, sort of like an endometriosis.

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If you have a rudimentary horn with

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endometrium, again, you're at a higher risk

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of miscarriage in general, and all of these

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have a risk of preterm labor, and that is

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because this uterus is not quite a normal size.

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So you're also at risk because it may not

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expand as much as normal of IUGR in your

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pregnancy, or intrauterine growth retardation,

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for the same reason that that uterus doesn't

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expand quite as much as a normal uterus.

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complete uterus would, you are at

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a higher risk of uterine rupture.

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So these patients are going to be

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watched throughout their pregnancy

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to watch to see how the fetus is

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growing and how the patient is doing.

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Treatment of this, you can't treat

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the unicornuate horn, that is what

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it is, but you can surgically resect

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that rudimentary horn if you have one.

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Again, if it's non-cavitary, no

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endometrium, you don't need to do that.

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So in general, going back to our embryology

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to understand what you're seeing here,

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why this looks the way it does, this

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is an incomplete or complete lack of

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development of one of the Müllerian ducts

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while the other one develops normally.

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So again, just remember one horn only

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look for that rudimentary horn, look

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to see if it has endometrium within it.

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And then if you can look to see if they

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seem to be communicating or if they're

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not communicating and that will help

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the surgeon decide what to do next.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

MRI

Gynecologic (GYN)

Body

Acquired/Developmental

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