Case of the Month August 2014, page 3

Answer: D

Explanation: There are two uterine horns with two separate endometrial canals. The right horn has echogenic endometrial tissue whereas the horn on the left is mostly filled by fluid. There is blood in the lower right horn as well. We can therefore infer that the left horn communicates freely with the vagina because there is blood and fluid in each. It is unclear whether the right horn also communicates with the vagina.

This finding is unrelated to the presence of the vaginal septum which caused hematometrocolpos. However, there is a clue in the patient’s history. The development of the kidneys and genital organs are closely related. The absence of a left kidney suggests that there may have been a developmental abnormality early in gestation. The uterus is formed by the fusion of two ducts (Mullerian). The closely associated Wolffian system which goes on to form the kidneys is necessary for the correct development of the uterus. The Wolffian system likely failed early in gestation which caused an arrest in the fusion of the uterus.

In the future this patient may benefit from a pelvic MRI to better evaluate how much fusion has actually taken place. Some women with this anomaly do not have any impact on their health or fertility. Others experience spontaneous abortions or premature deliveries. If she chooses to have children later in life, a multidisciplinary team including her obstetrician and radiologist will help determine the safest way for her to delivery her child.

CASE LESSON: The kidneys and genitourinary system are closely related. If there is an developmental abnormality in one, you must assess the other.


1. Acien and Acien. Achieves of Obstetrics and Gynecology 2010 July; 1424-1432. DOI: 10.3109/00016349.2010.512067

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