0:01

Our next case is in an adult.

0:03

This is another didelphys uterus.

0:05

So key findings here.

0:07

On our T2 axial field of

0:09

view, ovary, ovary, normal.

0:13

And you can see, I'll stop right there.

0:14

These are two very widely

0:17

disparate horns, right?

0:18

Here's the endometrium in this one.

0:19

You can see beautiful T2 bright endometrium.

0:21

This is your T2 dark junctional zone.

0:23

This is your myometrium, and then a very

0:25

light T2 dark serosal surface right here.

0:28

So horn over here, horn over

0:29

here, very widely disparate.

0:31

There's a huge cleft right here.

0:34

These are two different horns.

0:35

You follow them all the way down

0:36

and there are two separate cervices.

0:38

You can see them again,

0:39

sort of diverge right here.

0:41

So this is your classic appearance

0:42

of a didelphys uterus on an MRI.

0:46

So little to absolutely no fusion.

0:49

Again, it is always important to look for

0:51

a hemivagina. And in this particular case,

0:55

because we come down here, there's a

0:56

vagina here, there's a vagina here,

0:58

and there almost looks like there's

0:59

an odd separation between these two.

1:01

And this person did have hemivaginas here,

1:03

so the separation, or lack of fusion, continued

1:06

on through the vagina, right down here.

1:12

Here's your coronal view of it.

1:14

Sometimes your coronal might be the

1:15

best view, sometimes it's your axial.

1:18

But again, just so you can see here,

1:20

two completely separate cervices,

1:22

one over here, one over here, they come

1:25

close to one another, but they never

1:26

actually fuse to become one endometrium.

1:28

And again, two widely placed horns.

1:34

And in our case right here, let me

1:36

window level that for you a bit.

1:41

She has only one kidney.

1:44

So again, unilateral agenesis in this

1:46

particular case of the left kidney.

1:48

Other things to look for.

1:50

This was her preoperative.

1:52

So the MRI I just showed you

1:53

was actually postoperative.

1:55

This is how she presented earlier.

1:57

So ovary here, ovary here,

1:59

again, your didelphys, right?

2:01

In this case though,

2:01

the endometrium looks a bit different.

2:02

There's a fluid-fluid level

2:04

within the endometrium, right?

2:05

So this is going to be blood product.

2:07

So definitely a didelphys, but now you have

2:10

this fluid-filled structure right here.

2:12

As you follow this down,

2:15

it was in the left hemivagina.

2:16

So her left hemivagina was obstructed,

2:18

and so this was blood product.

2:20

Use your T1s there to definitely be for sure

2:25

that it's blood product, but you can see here

2:27

we have multiple fluid-fluid levels right here.

2:29

This is obstruction and blood

2:30

product and that needs to be fixed.

2:33

So if you do have a didelphys, you're still at

2:35

risk of an early labor similar in some sense to

2:37

the unicornuate because you have a uterus that

2:40

is smaller than usual, will not necessarily

2:42

expand to the normal size of a regular uterus.

2:45

So you are at risk of premature birth

2:47

and you're at risk for IUGR of the baby

2:49

because of those growth restrictions.

2:51

So those are things to keep in mind.

2:54

Surgically, there's nothing they can do

2:55

to change that, but you do need to look

2:57

for that septation or hemivagina to fix

3:01

that, especially if there's an obstruction.

3:03

That can be fixed and should be fixed.