Diagnostic ultrasound ( PDFDrive )

536 PART II Abdominal and Pelvic Sonography
A
B
FIG. 15.8 Cervical Pseudomass. (A) Transverse TVS of cervix shows central hypoechoic area simulating a mass (calipers). (B) Sagittal TVS in
same patient shows the smooth elongated nature of the inner portion of the cervix (between arrows) in a retroverted uterus. The inner portion of
cervix is sometimes relatively hypoechoic to the outer portion and can simulate a mass.
I. Hypoplasia/agenesis
II. Unicornuate
III. Didelphys
Communicating
Noncommunicating
IV. Bicornuate
Fundal
One horn
No cavity
V. Septate
VI. Arcuate
VII. DES drug related
Complete
Partial
FIG. 15.9 Drawing of Müllerian Abnormalities. DES, Diethylstilbestrol. (Reprinted by permission from the American Society for Reproductive
Medicine. The American Fertility Society classiications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation,
tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49(6):944-955. 55 )
reference line across the superior aspect of the myometrial edge
in the two cornual regions), the distinction narrows to a septate
(or subseptate) versus arcuate uterus. he term “subseptate” or
“partial septate” is sometimes used when the septum does not
extend all the way from the fundus to the cervix. he 1-cm
fundal clet criterion to distinguish septate (or arcuate) from
bicornuate uterus is a commonly used criterion, although other
methods have been suggested. 54,56,65,66
he signiicance of and diagnostic criteria for an arcuate uterus
are unclear. Arcuate uterus refers to slight indentation of the
fundal myometrium into the endometrium. here is debate about
whether it is truly an anomaly or just a normal variant, and
further debate about whether it has clinical importance. 56,67 Part
of the diiculty in sorting out these questions arises from
uncertainty in what criteria one uses for the diagnosis. We are
also unaware of criteria for distinguishing mild arcuate uterus
from a normal uterus. Suggested criteria for diagnosis of an
arcuate uterus are an angle greater than 90 degrees at the end
point of the fundal indentation 65 or a less than 1-cm indentation
of myometrium into the endometrium (from a reference line