Young female patient with a previously negative ultrasound examination for uterine anomalies. A repeat evaluation was performed using a 3D transvaginal approach with coronal multiplanar reconstruction (CMPR) for detailed uterine assessment.
3D transvaginal ultrasound with CMPR provided a high-quality coronal view of the uterus, allowing precise evaluation of the endometrial cavity and fundal contour.
A prominent internal fundal indentation was identified, with a measured depth of 20.6 mm. The myometrial wall thickness (WT) at the fundus measured 4.7 mm. The ratio between indentation depth (I) and wall thickness (WT) was calculated as 438%, significantly exceeding the diagnostic threshold of 110%.
The external uterine contour appeared normal, supporting the diagnosis of a septate uterus rather than a bicornuate configuration. The improved visualization obtained with 3D CMPR was essential in detecting the anomaly, which had been missed on prior examination.
Final diagnosis:
Septate uterus.
Differential diagnosis:
Bicornuate uterus, arcuate uterus, subseptate uterus.
Teaching points:
3D transvaginal ultrasound with coronal CMPR reconstruction is the gold standard for evaluating Müllerian anomalies. Quantitative assessment using septal depth and indentation-to-wall thickness ratio is critical for accurate diagnosis. A ratio ≥110% strongly supports the diagnosis of a septate uterus.
Injury/disease information:
A septate uterus is a congenital Müllerian duct anomaly caused by incomplete resorption of the midline septum. It is associated with adverse reproductive outcomes, including infertility, recurrent miscarriage, and preterm birth. Accurate diagnosis is important, as surgical correction (hysteroscopic septum resection) may improve reproductive outcomes.
