Imaging features of accessory cavitated uterine mass (ACUM): a peculiar yet correctable cause of dysmenorrhea

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This paper describes accessory cavitated uterine mass (ACUM), a rare developmental anomaly causing dysmenorrhea, and highlights USG and MRI's role in diagnosing this surgically correctable condition.

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This paper describes accessory cavitated uterine mass (ACUM), a rare mullerian developmental anomaly in young females that presents with chronic pelvic pain, dysmenorrhea, and infertility. Using high-level imaging discussion focused on ultrasound (USG) and MRI, it highlights that ACUM is a non-communicating accessory cavity within an otherwise normal uterus that is lined by functional endometrium and surrounded by myometrium-like smooth muscle, producing a uterus-like appearance. The authors emphasize that recognition of characteristic imaging features can help diagnose an often underrecognized but surgically correctable cause of dysmenorrhea, and the paper notes no additional explicit limitation in the provided text. Relevance to endometriosis: although this paper is not about endometriosis itself, it includes a closely related pelvic-pain differential involving gynecologic structural causes, and it specifically centers dysmenorrhea from an anatomic uterine anomaly rather than endometriosis—yet it is still pertinent to the broader endometriosis research corpus via keyword match and clinical overlap in pain presentation.

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Abstract

Accessory cavitated uterine mass (ACUM) is a rare form of developmental mullerian anomaly which causes chronic pelvic pain, dysmenorrhea and infertility in young females. It is a non-communicating, accessory cavity within an otherwise normal uterus, lined by functional endometrium and surrounded by myometrium-like smooth muscle cells which imparts it uterus-like appearance. USG and MRI are the imaging modalities which help in reaching the diagnosis. Knowledge of this entity and awareness of its imaging features can help diagnose this often underdiagnosed and surgically correctable cause of dysmenorrhea. Graphical abstract Similar content being viewed by others

References

Supermaniam S, Thye WL. Diagnosis and laparoscopic excision of accessory cavitated uterine mass in young women: Two case reports. Case Rep Womens Health. 2020 Apr 1;26:e00187. Iranpour P, Haseli S, Keshavarz P, Dehghanian A, Khalili N. Pelvic Pain and Adnexal Mass: Be Aware of Accessory and Cavitated Uterine Mass. Case Rep Med. 2021 Feb 11;2021:e6649663. Setty, T, Naftalin, J, Jurkovic, D. Accessory cavitated uterine malformations (ACUMs): an unfamiliar cause of dysmenorrhoea. The Obstetrician & Gynaecologist 2022; 24: 40– 49. https://doi.org/10.1111/tog.12787 Jain N, Verma R. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. Indian J Radiol Imaging. 2014;24(2):178–81. Betzler N, Brunes M, Anfelter P, Wedlund L, Persson J, Epstein E. Sonografic features of accessory cavitated uterine mass (ACUM) successfully treated with robotic assisted laparoscopic surgery- a case report. Clin Obstet Gynecol Reprod Med [Internet]. 2019 [cited 2021 Sep 12];5(6). Available from: https://www.oatext.com/sonografic-features-of-accessory-cavitated-uterine-mass-acum-successfully-treated-with-robotic-assisted-laparoscopic-surgery-a-case-report.php Putta T, John R, Simon B, Sathyakumar K, Chandramohan A, Eapen A. Imaging Manifestations of Accessory Cavitated Uterine Mass—A Rare Mullerian Anomaly. Indian J Radiol Imaging [Internet]. 2021 Sep 7 [cited 2021 Sep 15]; Available from: http://www.thieme-connect.de/DOI/DOI?https://doi.org/10.1055/s-0041-1735504 Acién P, Bataller A, Fernández F, Acién MI, Rodríguez JM, Mayol MJ. New cases of accessory and cavitated uterine masses (ACUM): a significant cause of severe dysmenorrhea and recurrent pelvic pain in young women. Hum Reprod. 2012 Mar 1;27(3):683–94. Peyron N, Jacquemier E, Charlot M, Devouassoux M, Raudrant D, Golfier F, et al. Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity. Eur Radiol. 2019 Mar;29(3):1144–52.

Acknowledgements

None. Funding None. Author information Authors and Affiliations Contributions SG: Literature search, manuscript preparation. SM: Conception and design of work, manuscript preparation and editing. SV, NM, SRM, VK: Manuscript—editing. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest All authors declare that they have no conflict of interest to disclose. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Gupta, S., Manchanda, S., Vyas, S. et al. Imaging features of accessory cavitated uterine mass (ACUM): a peculiar yet correctable cause of dysmenorrhea. Abdom Radiol 48, 1100–1106 (2023). https://doi.org/10.1007/s00261-022-03790-0 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-022-03790-0

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Condition tags

dysmenorrheachronic_pelvic_pain

MeSH descriptors

Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Dysmenorrhea Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Female Female Female Female Female

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