Interactive Transcript
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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.
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