Mullerian anomalies

Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pel-licer A (1997) Reprodudive impact of congenital Mullerian anomalies. Hum Reprod 12 2277-2281... 

The American Fertility Society (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 49 944-955... 

Buttram VC Jr., Gibbons WE (1979) Mullerian anomalies a proposed classification. (An analysis of 144 cases). Fertil... 

Minto CL, HoUings N, Hall-Craggs M, Creighton S (2001) Magnetic resonance imaging in the assessment of complex Mullerian anomalies. Bjog 108 791-797... 

Congenital malformations of the uterus, also termed Mullerian duct anomalies (MDA) are an uncommon, but often treatable cause of infertility. Estimates of its frequency vary widely owing to different patient... 

CAN Fertility Society (AFS) [12] presented a consensus in classification of uterovaginal anomalies and published a schematization system that is widely accepted among specialists. Other used classification systems are referenced [13-15]. Most Mullerian duct anomalies occur sporadically and some reports give descriptions of the patterns of inheritance or of exposure to teratogenic agents such as di-ethyl-stilbestrol (DES) and thalidomide [16]. 

Fig. 4.1. Classification system of Mullerian duct anomalies (American Fertility Society) [12]...

Septate uterus is the most common Mullerian duct anomaly and is unfortunately associated with the poorest reproductive outcome. Because of different treatment options, septate uterus must be differenti-... 

Troiano RN, McCarthy SM (2004) Mullerian duct anomalies imaging and clinical issues. Radiology 233 19-34... 

Byrne J, Nussbaum-Blask A, Taylor WS, Rubin A, Hill M, O Donnell R, Shuhnan S (2000) Prevalence of Mullerian duct anomalies detected at ultrasound. Am J Med Genet 945-12... 

Wu MH, Hsu CC, Huang KE (1997) Detection of congenital mullerian duct anomalies using three-dimensional ultrasound. J Clin Ultrasound 25 487-492... 

Carrington BM, Hricak H,Nuruddin RN, Secaf E, Laros RK Jr., Hill EC (1990) Mullerian duct anomalies MR imaging evaluation. Radiology 176 715-720... 

A longitudinal vaginal septum (Fig. 12.9) occurs as a consequence of incomplete fusion of the miille-rian ducts or resorption failure of the vaginal septum. This anomaly is also typically associated with other malformations of the mullerian ducts [septate uterus, bicornuate uterus, uterus didelphys (Fig. 12.9), cervical duplication] [2j. 

Magnetic resonance (MR) imaging is suitable for assessing female infertility, as infertility typically results from benign processes in women of reproductive age. The causes of female infertility include ovulatory disorders (i.e., pituitary adenoma and polycystic ovarian syndrome), disorders of the fallopian tubes (i.e., hydrosalpinx and pelvic inflammatory disease), uterine disorders (i.e.,mullerian duct anomaly, aden-omyosis, and leiomyoma), and pelvic endometriosis. 

The applications of MR imaging include evaluation of the functioning uterus and ovaries, visualization of pituitary adenomas, differentiation of mullerian duct anomalies, and accurate noninvasive diagnosis of adenomyosis, leiomyoma, and endometriosis. In addition, MR imaging helps predict the outcome of conservative treatment for adenomyosis, leiomyoma, and endometriosis and may lead to selection of better treatment plans and management... 

Mullerian duct anomalies may be depicted by HSG however, the complex situation of the various classes of anomalies seem to be better defined by sonography or MR imaging. 

Failure of normal development of the mullerian ducts causes uterine agenesis or hypoplasia. Patients present with primary amenorrhea in adolescence. Agenesis or hypoplasia of any part of the genital tract (vagina, cervix, uterus, tubes) may occur either in isolation or, more, commonly, in combination. This relatively uncommon class of anomalies accounts for approximately 5% of mullerian duct anomalies. Vaginal agenesis is the most common subtype, and is often accompanied by uterine agenesis. 

Fig. 16.15. The most widely accepted classification of mullerian duct defects, adressinguterovaginal anomalies...

Rock JA (1997) Surgery for anomalies of the mullerian ducts. In Rock JA, Thompson JD (eds) Te Linde s operative gynecology, 8th edn. Lippincott-Raven, Philadelphia, pp 687-729... 

Incomplete fusion of the distal segments of the two mullerian ducts results in various degrees of bifidity of the uterus and/or vagina (Jarcho 1946) (Fig. 7.6). Disorders of the lateral fusion are rare in the general population and, in the absence of obstruction, are asymptomatic during childhood or at puberty. However, these anomalies are more frequently encoun-... 

Due to the close developmental relationship of the urinary and the genital tract, malformations frequently occur in both of these systems. Major renal anomalies are common in patients presenting with unilateral obstruction or agenesis of duplicated structures derived from the mullerian duct. 

Pediatric radiologists will commonly come across mUllerian duct anomalies at two different stages of a girl s life. In neonates diagnostic requests encompass evaluation of a palpable abdominal mass and delineation of associated genital malformation in urogenital sinus anomalies. In adolescent girls delay in puberty or primary amenorrhea as well as pelvic... 

---