NHÓM V

NGUYỄN THỊ THU THẢO

NGUYỄN THỊ NGUYỆT
NGUYỄN VĂN THÚC
ĐỖ ĐĂNG TÂN
TRẦN THỊ LÝ
 Bệnh nhân nữ 13 tuổi vào viện vì đau tức bụng
vùng hạ vị 1 tuần nay.
 Tiền sử:
-Chưa có tiền sử bệnh lí trước đây.
-Chưa có kinh nguyệt.
 CTM
 SHM

 TPT nước tiểu

=> Không thấy bất thường
Siêu âm
 Dị dạng tử cung: tử cung có vách ngăn hoàn
toàn với vách ngăn dọc âm đạo không thủng.
 after 6 weeks gestation, the absence of
müllerian-inhibiting factor in the female fetus
promotes bidirectional growth of the
müllerian ducts
 9 and 13 weeks gestation : paired müllerian
ducts along the lateral aspect to form the
primordium uterovaginal.
 14 and 18 weeks gestation:the fused
müllerian ducts undergo a process of
reabsorption of the intervening uterovaginal
septum
 6-9w: uterine aplasia
 9-13w: uterine duplications:
a. Uterus didelphys (2 horn, 2 cervix).
b. Bicornuate uterus (2 horn, 1cervix).
 14-18w: septate uterus,arcuate uterus
 5.5% in the general population
 8% in infertile women
 13.3% in women with a history of miscarriage
 24.5% among women who have experienced
miscarriage and infertility
=>arcuate uterus was most common, affecting
3.9% of women.
 Majority are asymptomatic.
 Obstruction of the Müllerian duct: abdominal
mass and dysmenorrhea.
 Recurrent miscarriages
 Infertility
HSG
 allows evaluation of only the component of
the uterine cavity
 cannot help to identify the type of MDA
Ultrasound
 should be performed initially
 confirms any structural abnormalities of the
genital tract
 sometimes cannot help to identify the type of
MDA (especially on 2D imaging alone)
MRI
 valuable noninvasive technique
 evaluation of the female pelvic anatomy
 accurate MDA classification
 Early developmental failure of the müllerian
ducts results in agenesis or hypoplasia of the
proximal two-thirds of the vagina, cervix, and
uterus
 This anomaly is part of the Mayer-
Rokitansky-Küster-Hauser syndrome
 1/3 will have renal anomalies.
 absence of the cervix and
uterus or rudimentary
uterus
 vaginal atresia
 normal ovaries
 A unicornuate uterus results from normal
development of one müllerian duct and near
complete to complete arrested development of
the contralateral duct
 Four subtypes:
 Uterus didelphys results from complete failure of
müllerian duct fusion.
 Each duct develops fully with duplication of the
uterine horns, cervix, and proximal vagina.
Bicornuate uterus results from
incomplete or partial fusion of the
müllerian ducts
Bicornuate uterus is characterized by the
presence of a cleft (>1 cm in depth at MR
imaging) in the external contour of the uterine
fundus, similar to uterus didelphys.
 The septum is a result of complete or partial
failure of reabsorption of the uterovaginal
septum
 have a normal convex external fundal
contour.
• An arcuate uterus occurs with near
reabsorption of the uterovaginal septum
• have a normal convex external fundal
contour
DES-related anomaly of the uterus
involves a hypoplastic or T-shaped
uterus
Features of a T-shaped
uterus include:
-a widened lower uterine
segment
-a small hypoplastic
uterus
-a narrowed fundal
endometrial canal
-irregular endometrial
margins
-intraluminal uterine
filling defects
Many patients are asymptomatic and require no
treatment. However, where obstruction occurs,
surgical intervention is usually required and
may result in permanent infertility - counseling
is required.
• MDAs are a complex and
broad spectrum of
developmental anomalies
that can manifest in a
variety of both clinical and
imaging scenarios.
• US, MR imaging is
currently the imaging
modality of choice due to
its reliability and accuracy
• It is essential to accurately
classify MDAs, as surgical
planning often varies
widely between MDA