Radiologic Diagnostics of Uterus Didelphys: A Case Report

Introduction Congenital uterine malformations are the consequence of anomalous development of the uterine septum during the development of Mullerian ducts [1]. Diagnosis of these anomalies, while dependent on imaging and surgical findings, is often subjective. Nevertheless, MRI distinctly defines pelvic anatomy allowing for pinpointing other associated anomalies, particularly those of the reproductive system [2]. Case Presentation A 31–year–old female patient with a known history of endometriosis, presented with pain in the left iliac region that began with the onset of menstruation and did not subside after menstruation. Based on the clinical history and imaging findings, endometriosis was considered the primary etiology of the pain. Abdominal ultrasound (US) findings exhibited the left ovary to be non-mobile with solid mass and several enlarged follicles. Transvaginal US showed a very thin endometrium, enlarged left ovary, containing a cyst filled with hemorrhagic content. In addition, the US revealed a dense solid mass in the projection of the left ovary with a similar mass right next to the first one. No uterine duplication or cervical anomaly was identified on US or during gynecological examination. The patient underwent magnetic resonance imaging (MRI) with routine sequences and intravenous contrast enhancement. The MRI revealed that the patient had a rare congenital anomaly – uterus didelphys, presenting as two separate uterine bodies and two cervices. The patient underwent a laparoscopic surgery without any further complications and for the post–operative treatment progestin was prescribed in continuous regimen. Discussion The rarity of this developmental uterine abnormality has limited the availability of robust data regarding long-term clinical outcomes. Diagnosis of uterine didelphys is established through imaging-based evaluation, including US, MRI, and hysterosalpingography [3]. Conclusions This case report highlights that some anatomical anomalies may present as secondary findings to the main complaint – pelvic pain caused by endometriosis. These findings emphasize the importance of a holistic approach to each patient and the ability to diagnose the pathology with comprehensive imaging, especially MRI, and surgical evaluation.