Learning objectives
- To review the Robert’s uterus as a rare unique müllerian duct anomaly.
It is also known as asymmetric septate uterus.
- To evaluate the impact of MRI in the diagnosis of Robert’s uterus and its associated complications as hematometra and hematosalpinx.
- To explain the advantages of MRI as the modality of choice highlighting technical aspects as perfect anatomical detail and direct visualization of the uterine contour,
especially on coronal images.
- The importance of early and accurate diagnosis of this condition in guiding...
Background
There are various forms of mullerian ducts anomalies and each anomaly is distinctive.
The reported incidence of them is 0.1-3.5%.
The incidence has been increased due to the availability of better imaging facilities.
The widely accepted American Fertility Society (AFS) classification organizes mullerian duct anomalies according to major uterine anatomic defect and allows for standardized reporting methods.
Septate uterus (AFS Class V) is the most common,
resulting from incomplete resorption of the medial septum after complete fusion of the mullerian ducts has occurred; variations exist...
Findings and procedure details
When suspecting a mullerian duct anomaly (MDA),
a plain MRI study of the pelvis should be performed with the following sequences: T2-weighted (T2W) images in coronal,
axial and sagittal planes,
T1W axial,
T1 Fat suppressed sequences axial,
coronal and sagittal images and T2 coronal Fat suppressed sequence.
Coronal T2W images are ideal for demonstrating asymmetric uterine septum as well as normal uterine fundus outer contour (figure 1).
The lower portion of the septum is transversely oriented and obstructing one endometrial cavity leading to its distension...
Conclusion
In conclusion,
Robert’s uterus is a very rare müllerian duct anomaly,
which can be well evaluated with MRI. It should be considered in the differential diagnosis of young female with severe dysmenorrhea inspite of normal menstruation.
Early diagnosis is important,
as minimally invasive procedures may be more effective if detected before the formation of hematosalpinx or adnexal endometriomas.
Personal information
Dr Nehal Mohamed Saloum.
Clinical Fellow,
Diagnostic Imaging.
Hamad Medical Corporation,
Doha,
Qatar.
Email:
[email protected].
References
Bhuyar S,
Deshmukh P.
Robert’s uterus with menstrual retention – a rare müllerian anomaly.
Sri Lanka Journal of Obstetrics and Gynecology 36.2 (2014): 43–4.
Dewan KA,
Hefeda MM,
ElKholy DE.
Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging.
Egypt J Radiol Nucl Med 45.3 (2014): 987-995.
Mittal P,
et al.
Magnetic Resonance Imaging (MRI) Depiction of Robert’s Uterus: A Rare Mullerian Duct Anomaly Presenting with Cyclical Pain in Young Menstruating Woman.
Pol J Radiol 82 (2017): 134-6.
Marcal L,...