0:02

Our next case is of a 24-year-old

0:04

who comes in with pelvic pain.

0:06

We'll start here with a transverse

0:07

cine clip of the uterus.

0:12

You can see some roiling

0:13

bowel contents over here.

0:14

We started up at the fundus, so this

0:16

is going to be your uterus right here.

0:18

We have these two little echogenic areas

0:21

right here, so it suggests that there's

0:23

two separate, almost horns in this case.

0:25

We're seeing increased through transmission

0:27

behind them because endometrium is a lot

0:29

of fluid, fluid-filled structures and

0:32

vascularity, and then they fuse right here.

0:34

So now we have one endometrium all the way

0:36

down to the cervical region, one cervix,

0:40

one cervix as we follow it all the way down.

0:43

Scroll back up through it with my mouse out of

0:45

the way here, and we see one endometrial canal

0:49

in the cervix, and then in the lower uterine

0:51

segment as we come up towards the fundus.

0:54

They sort of split or diverge right here.

0:58

So it's really hard, again, to get a fundal

1:00

view of a uterus on a transvaginal ultrasound,

1:04

so you really are reliant on your 3D imaging.

1:06

So that's what we have here.

1:07

This is where they were acquiring

1:08

the 3D imaging, and this is what

1:11

we ended up getting right here.

1:14

So, here is your endometrial cavity,

1:16

and you can see a bit of a dip here.

1:18

Right here, and you have a fundal contour

1:20

out here, which looks pretty normal; it dips

1:24

in just a little bit, but not very much.

1:26

If you can measure on these, it's nice to

1:28

measure how far those dips are, but you can also

1:31

see that this is a partial septate, borderline

1:34

arcuate uterus in this particular case.

1:37

So you can see on the 3D right here, the contour

1:39

is fairly normal right here, and sort of mimics

1:42

right here on the endometrium right here.

1:43

We do not have a complete septate

1:45

all the way down right here.

1:46

So this is either an arcuate, borderline

1:49

partial septate uterus right here.

1:52

So treatment for these, again, is a resection

1:54

of the septum if there definitely is

1:56

one; if they have a history of repeated

1:57

miscarriages, and future pregnancies should

2:00

be able to implant and grow normally.

2:03

So differential, again, for a case like

2:04

this would have been a bicornuate

2:06

uterus, but your focus is on the fundal

2:08

contour here, which is completely normal.